Abstract 10570: Inflammation During Early Post-Acute Covid-19 is Associated With Reduced Exercise Capacity and Long Covid Symptoms After 1 Year

Abstract

Introduction: Mechanisms underlying cardiopulmonary symptoms following SARS-CoV-2 infection (post-acute sequelae of COVID-19 “PASC” or “Long COVID”) remain unclear. The purpose of this study was to elucidate the pathophysiology of PASC using cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring. Methods: We performed CMR, CPET, and ambulatory rhythm monitoring among adults > 1 year after confirmed SARS-CoV-2 infection in the UCSF Long-Term Impact of Infection with Novel Coronavirus cohort (LIINC; NCT04362150) and correlated findings with previously measured biomarkers. We used logistic regression to estimate associations with PASC symptoms and linear regression to estimate differences by symptoms adjusted for confounders. Results: Out of 120 participants, 46 participants (unselected for symptom status) had cardiac testing performed at median 17 months after infection. Median age was 52, 18 (39%) were female, and 6 (13%) were hospitalized for severe acute infection. On CPET (n=39), 13/23 (57%) with symptoms had reduced exercise capacity (peak VO2<85% predicted) compared to 2/16 (13%) without symptoms (p=0.008). Adjusted peak VO 2 was 5.9 ml/kg/min lower (-9.6 to -2.3; p=0.002) or -21% predicted (-35 to -7; p=0.006) among those with symptoms. Chronotropic incompetence was present among 9/15 (60%) with reduced peak VO2 (adjusted heart rate reserve<80%: OR 15.6 for reduced peak VO2, 95%CI 1.30-187; p=0.03). Inflammatory markers (hsCRP, IL-6, TNF-α) and SARS-CoV-2 antibody levels measured early in PASC (median 3.5-6 months after infection) were negatively correlated with peak VO2 more than 1 year later (Figure). Conclusions: Cardiopulmonary symptoms and elevated inflammatory markers present early in PASC are associated with reduced exercise capacity during CPET >1 year following COVID-19. Chronotropic incompetence may explain reduced exercise capacity among some individuals with PASC.