Factors of persistent limited exercise tolerance in patients after COVID-19 with normal left ventricular ejection fraction

Abstract

Abstract Background Exercise intolerance de novo is one of the most common reported symptoms in patients (pts) recovering from COVID-19. Purpose The present study determines etiological and pathophysiological factors influencing the mechanism of exercise intolerance in the COVID-19 survivors. Therefore, the factors affecting percent predicted oxygen uptake at peak exercise VO2 (%VO2pred) in pts after COVID-19 with normal left ventricular ejection fraction were assessed. Methods and results The 120 consecutive patients from the Department of Cardiology recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examinations, laboratory test results, echocardiography using Vivid E95 – GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), and spiroergometry using The MetaSoft® Studio application were analysed. The subjects were divided into the two following groups: study i.e. pts with worse oxygen uptake (%VO2pred <80%; N=47) and control including these cases with %VO2pred ≥80% (N=73) – Table 1. Pts with %VO2pred <80% presented significantly lower global peak systolic strain (GLPS) [p=0.03], tricuspid annular plane systolic excursion (TAPSE) [p=0.002] and late diastolic filling velocity (A) [p=0.004] compared to controls – Figure 1. The male gender (p=0.007) and the percent of total body water content (TBW %) (p=0.02) were significantly higher in study in comparison to the control group. The results of multiple logistic regression model independently associated with %VO2pred were as follows: A (OR 0.4, 95% CI: 0.17–0.95; p=0.03) and gender (OR 2.52, 95% CI: 1.07–5.91; p=0.03). Conclusions Males have over twice risk of persistent limited exercise tolerance after COVID-19 infection than females. The lower late diastolic filling velocity, tricuspid annular plane systolic excursion, worse global peak systolic strain, and hydration status are connected with limited exercise tolerance after COVID-19 in patients with normal left ventricular ejection fraction. Funding Acknowledgement Type of funding sources: None.