心肺运动测试可排除 COVID-19 康复患者的重大疾病。

IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Bmj Military Health Pub Date : 2024-07-24 DOI:10.1136/military-2022-002193
D A Holdsworth, R M Barker-Davies, R R Chamley, O O'Sullivan, P Ladlow, S May, A D Houston, J Mulae, C Xie, M Cranley, E Sellon, J Naylor, M Halle, G Parati, C Davos, O J Rider, A B Bennett, E D Nicol
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引用次数: 0

摘要

目的:COVID-19 后综合征是一项健康和经济挑战,约有 10% 的 COVID-19 康复患者会受到影响。对 COVID-19 后综合征患者的准确评估因健康焦虑和症状性自主神经功能障碍而变得复杂。我们试图确定症状或客观心肺运动测试是否能预测具有临床意义的结果。这包括所有患者的症状报告、病史、检查、肺活量测定、超声心动图和心肺运动测试 (CPET),以及胸部 CT、双能 CT 肺血管造影术和心脏磁共振成像(如有必要)。对症状、CPET 结果以及是否存在重大病变进行了回顾。对数据进行分析,以确定可用于排除重大疾病的诊断策略:7/113(6%)名患者经心胸外科多学科团队(MDT)判定患有临床重大疾病。与无明显疾病的患者相比,这些患者的体能(V̇O2 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min;p=0.002)和功能能力(峰值功率 200 (±36) vs 247 (±55) W;p=0.026)均有所下降。简单的 CPET 标准(摄氧量(VO2)>预测值的 100%,分钟通气量(VE)/二氧化碳排出量(VCO2)斜率为 2 斜坡 结论:在 SARS-CoV-2 的康复人群中,令人欣慰的是几乎没有出现器官病变。通过 CPET 和功能测试,而不是报告的症状,可以排除有临床意义的疾病。
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Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19.

Objective: Post-COVID-19 syndrome presents a health and economic challenge affecting ~10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings.

Methods: 113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease.

Results: 7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O2 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V̇O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO2) slope <30.0 or VE/V̇CO2 slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar-arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease.

Conclusions: In a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.

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Bmj Military Health
Bmj Military Health MEDICINE, GENERAL & INTERNAL-
CiteScore
3.10
自引率
20.00%
发文量
116
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