Reduced Exercise Capacity, Chronotropic Incompetence, and Early Systemic Inflammation in Cardiopulmonary Phenotype Long Coronavirus Disease 2019

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Abstract
Background: Mechanisms underlying persistent cardiopulmonary symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (postacute sequelae of coronavirus disease 2019 [COVID-19; PASC] or “long COVID”) remain unclear. This study sought to elucidate mechanisms of cardiopulmonary symptoms and reduced exercise capacity. Methods: We conducted cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring among adults >1 year after SARS-CoV-2 infection, compared those with and those without symptoms, and correlated findings with previously measured biomarkers. Results: Sixty participants (median age, 53 years; 42% female; 87% nonhospitalized; median 17.6 months after infection) were studied. At CPET, 18/37 (49%) with symptoms had reduced exercise capacity (1 year after COVID-19 were associated with reduced exercise capacity, which was associated with earlier inflammatory markers. Chronotropic incompetence may explain exercise intolerance among some with “long COVID.”
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Funding Information
  • Ed and Pearl Fein Foundation
  • National Heart, Lung, and Blood Institute
  • National Institutes of Health (K12 HL143961)
  • Division of Cardiology at Zuckerberg San Francisco General
  • UCSF AIDS Research Institute and UCSF/Gladstone Center for AIDS Research
  • National Institute of Allergy and Infectious Diseases (3R01A1141003-03S1 to T. J. H., P30AI027763)
  • UCSF-Gladstone Center for AIDS Research
  • National Center for Advancing Translational Sciences (UL1TR001872)

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