Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome

Angelos Vontetsianos; Nikolaos Chynkiamis; Maria Ioanna Gounaridi; Christina Anagnostopoulou; Christiana Lekka; Stavroula Zaneli; Nektarios Anagnostopoulos; Evangelos Oikonomou; Manolis Vavuranakis; Nikoletta Rovina; Andriana I. Papaioannou; Georgios Kaltsakas; Nikolaos Koulouris; Ioannis Vogiatzis

doi:10.3390/jcm13144144

Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome

Angelos Vontetsianos, Nikolaos Chynkiamis^*, Maria Ioanna Gounaridi, Christina Anagnostopoulou, Christiana Lekka, Stavroula Zaneli, Nektarios Anagnostopoulos, Evangelos Oikonomou, Manolis Vavuranakis, Nikoletta Rovina, Andriana I. Papaioannou, Georgios Kaltsakas, Nikolaos Koulouris, Ioannis Vogiatzis

^*Corresponding author for this work

Sport Exercise and Rehabilitation Department

Research output: Contribution to journal › Article › peer-review

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Abstract

Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e’ ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e’ with WRpeak (r = −0.325) and VO2peak (r = −0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO2peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO2peak (r = −0.358 and r = −0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.

Original language	English
Article number	4144
Number of pages	12
Journal	Journal of Clinical Medicine
Volume	13
Issue number	14
DOIs	https://doi.org/10.3390/jcm13144144
Publication status	Published - 16 Jul 2024

Keywords

long COVID-19 syndrome
cardiopulmonary exercise test
echocardiography
exercise tolerance

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Vontetsianos, A., Chynkiamis, N., Gounaridi, M. I., Anagnostopoulou, C., Lekka, C., Zaneli, S., Anagnostopoulos, N., Oikonomou, E., Vavuranakis, M., Rovina, N., Papaioannou, A. I., Kaltsakas, G., Koulouris, N., & Vogiatzis, I. (2024). Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome. Journal of Clinical Medicine, 13(14), Article 4144. https://doi.org/10.3390/jcm13144144

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title = "Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome",

abstract = "Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e{\textquoteright} ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e{\textquoteright} with WRpeak (r = −0.325) and VO2peak (r = −0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO2peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO2peak (r = −0.358 and r = −0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.",

keywords = "long COVID-19 syndrome, cardiopulmonary exercise test, echocardiography, exercise tolerance",

author = "Angelos Vontetsianos and Nikolaos Chynkiamis and Gounaridi, {Maria Ioanna} and Christina Anagnostopoulou and Christiana Lekka and Stavroula Zaneli and Nektarios Anagnostopoulos and Evangelos Oikonomou and Manolis Vavuranakis and Nikoletta Rovina and Papaioannou, {Andriana I.} and Georgios Kaltsakas and Nikolaos Koulouris and Ioannis Vogiatzis",

year = "2024",

month = jul,

day = "16",

doi = "10.3390/jcm13144144",

language = "English",

volume = "13",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

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number = "14",

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Vontetsianos, A, Chynkiamis, N, Gounaridi, MI, Anagnostopoulou, C, Lekka, C, Zaneli, S, Anagnostopoulos, N, Oikonomou, E, Vavuranakis, M, Rovina, N, Papaioannou, AI, Kaltsakas, G, Koulouris, N & Vogiatzis, I 2024, 'Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome', Journal of Clinical Medicine, vol. 13, no. 14, 4144. https://doi.org/10.3390/jcm13144144

TY - JOUR

T1 - Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome

AU - Vontetsianos, Angelos

AU - Chynkiamis, Nikolaos

AU - Gounaridi, Maria Ioanna

AU - Anagnostopoulou, Christina

AU - Lekka, Christiana

AU - Zaneli, Stavroula

AU - Anagnostopoulos, Nektarios

AU - Oikonomou, Evangelos

AU - Vavuranakis, Manolis

AU - Rovina, Nikoletta

AU - Papaioannou, Andriana I.

AU - Kaltsakas, Georgios

AU - Koulouris, Nikolaos

AU - Vogiatzis, Ioannis

PY - 2024/7/16

Y1 - 2024/7/16

N2 - Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e’ ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e’ with WRpeak (r = −0.325) and VO2peak (r = −0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO2peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO2peak (r = −0.358 and r = −0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.

AB - Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e’ ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e’ with WRpeak (r = −0.325) and VO2peak (r = −0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO2peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO2peak (r = −0.358 and r = −0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.

KW - long COVID-19 syndrome

KW - cardiopulmonary exercise test

KW - echocardiography

KW - exercise tolerance

U2 - 10.3390/jcm13144144

DO - 10.3390/jcm13144144

M3 - Article

SN - 2077-0383

VL - 13

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 14

M1 - 4144

ER -