背景:COVID-19感染后,10-20%的患者患有持续超过12周的不同症状(长COVID,LC)。运动不耐受和疲劳在LC中很常见。目的是测量具有这些症状的LC患者的最大运动能力,并分析该能力是否与休息时以及运动和恢复期间的心率(HR)反应有关。找出可能的交感神经过度活动,自主神经失调或变时机能不全。
方法:对101例LC患者进行心肺运动试验,他们被允许参加运动测试。他们中的大多数人(86%)在急性COVID-19感染期间在家中接受了治疗。峰值摄氧量(VO2peak),运动最后4分钟的最大功率(Wlast4),HR,和其他运动测试变量在有或没有主观运动不耐受的情况下进行比较,疲劳,或者两者兼而有之。
结果:运动不耐受患者感染COVID-19后平均12.7个月(SD5.75)进行测量(EI组,19名患者),疲劳(F组,31名患者),他们的组合(EI+F组,37名患者),或者两者都不是(N组,14名患者)。运动能力是,意思是,在所有症状组中都是正常的,并且在它们之间没有显着差异。最大运动时,EI+F组的HR高于N组(169/minvs.158/min,p=0.034)和运动后10分钟(104/minvs.87/min,p=0.028)。独立于症状,12例患者符合与Wlast4轻度降低相关的自主神经障碍标准(73%vs.91%的性生活,年龄,高度,和基于体重的参考值p=0.017)和13以最低的Wlast4(63%vs.93%,p<0.001),VO2peak(70%vs.94%,p<0.001),收缩压的最低增幅(50mmHgvs.67mmHg,p=0.001),与没有这些特征的患者相比,轻微心电图发现的患病率最高(p=0.017)。在N组中,变时机能不全的患病率最高(p=0.022)。
结论:这项针对不同症状的LC患者的研究表明,心肺运动能力平均正常,大多数患者的交感神经活动增加。然而,通过Wlast4或VO2peak测定,我们确定了自主神经失调或变时机能不全的亚组,其运动能力降低.主观运动不耐受和疲劳对运动能力水平的预测较差。结果可用于计划从LC的康复以及选择适合的患者。
BACKGROUND: After COVID-19 infection, 10-20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence.
METHODS: Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both.
RESULTS: The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p < 0.001), VO2peak (70% vs. 94%, p < 0.001), the lowest increase of systolic blood pressure (50 mmHg vs. 67 mmHg, p = 0.001), and the greatest prevalence of slight ECG-findings (p = 0.017) compared to patients without these features. The highest prevalence of chronotropic incompetence was seen in the group N (p = 0.022).
CONCLUSIONS: This study on LC patients with different symptoms showed that cardiopulmonary exercise capacity was in mean normal, with increased sympathetic activity in most patients. However, we identified subgroups with dysautonomia or chronotropic incompetence with a lowered exercise capacity as measured by Wlast4 or VO2peak. Subjective exercise intolerance and fatigue poorly foresaw the level of exercise capacity. The results could be used to plan the rehabilitation from LC and for selection of the patients suitable for it.