Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19.
Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19.
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症状持续性，尽管心肺健康有所改善 - 纵向CMR，CPET和肺功能测试的见解。
DOI：
10.1016/j.eclinm.2021.101159
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发表时间：
2021-11
影响因子：
15.1
通讯作者：
Raman B
中科院分区：
文献类型：
--
作者：
Cassar MP;Tunnicliffe EM;Petousi N;Lewandowski AJ;Xie C;Mahmod M;Samat AHA;Evans RA;Brightling CE;Ho LP;Piechnik SK;Talbot NP;Holdsworth D;Ferreira VM;Neubauer S;Raman B
冠状病毒病（COVID-19）感染后心肺异常和症状的纵向轨迹尚不清楚。我们试图描述既往住院患者的自然病史，将其与对照组进行比较，并评估COVID-19后6个月症状与心肺功能损害之间的关系。在2020年3月14日至5月25日期间招募的58名患者和30名匹配对照（单次访视）在COVID-19后3个月接受了问卷调查、心脏和肺磁共振成像（CMR）、心肺运动试验（CPET）和肺功能测定。其中，46名患者在6个月时返回接受随访评估。在2-3个月时，83%的患者至少有一种心肺症状，而对照组为33%。患者和对照组的双心室容积和功能相当。2-3个月时，患者的天然心脏T1（纤维炎症标志物）和晚期钆增强（LGE，局灶性纤维化标志物）增加。60%的患者CMR时有肺实质异常，55%的患者CPET时峰值氧耗量（pV今O2）降低。到6个月时，52%的患者仍有症状。CMR时，右心室（RV）舒张末期容积指数（-4统计学3 mls/m2，P=0·005）降低，RV射血分数（+3统计学2%，P=0·0003）增加。天然T1和LGE改善，与对照组相当。与对照组相比，患者的肺实质异常和峰值VO 2虽然更好，但仍异常。31%的患者pV现今O2降低，继发于症状限制和肌肉损伤。患者的心脏病症状与CMR、肺功能或CPET指标无关。在患者中，心肺异常随着时间的推移而改善，尽管一些测量相对于对照组仍然异常。COVID-19后6个月的持续症状与心肺健康的客观指标无关。作者的工作得到了NIHR牛津生物医学研究中心，牛津英国心脏基金会（BHF）卓越研究中心（RE/18/3/34214），英国研究创新和惠康信托基金的支持。该项目是名为PHOSP-COVID住院后COVID-19研究的合作研究计划中的三级研究（C-MORE）的一部分：由医学研究理事会和卫生与社会护理部/国家卫生研究所资助的了解和改善长期健康结果的国家联盟（MR/V027859/1）ISRCTN编号10980107。
The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19. Fifty-eight patients and thirty matched controls (single visit), recruited between 14th March - 25th May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months. At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T1 (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O2) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m2, P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O2, although better, were abnormal in patients versus controls. 31% had reduced pV̇O2 secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures. In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health. The authors’ work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.
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影响因子：
4.6
作者：
Barizien N;Le Guen M;Russel S;Touche P;Huang F;Vallée A
通讯作者：
Vallée A
影响因子：
2.3
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Mohr A;Dannerbeck L;Lange TJ;Pfeifer M;Blaas S;Salzberger B;Hitzenbichler F;Koch M
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Koch M
影响因子：
2.7
作者：
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影响因子：
24
作者：
Giustino G;Croft LB;Stefanini GG;Bragato R;Silbiger JJ;Vicenzi M;Danilov T;Kukar N;Shaban N;Kini A;Camaj A;Bienstock SW;Rashed ER;Rahman K;Oates CP;Buckley S;Elbaum LS;Arkonac D;Fiter R;Singh R;Li E;Razuk V;Robinson SE;Miller M;Bier B;Donghi V;Pisaniello M;Mantovani R;Pinto G;Rota I;Baggio S;Chiarito M;Fazzari F;Cusmano I;Curzi M;Ro R;Malick W;Kamran M;Kohli-Seth R;Bassily-Marcus AM;Neibart E;Serrao G;Perk G;Mancini D;Reddy VY;Pinney SP;Dangas G;Blasi F;Sharma SK;Mehran R;Condorelli G;Stone GW;Fuster V;Lerakis S;Goldman ME
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Goldman ME
医学研究委员会（MRC）呼吸困难量表作为慢性阻塞性肺病患者残疾度量标准的实用性
影响因子：
10
作者：
Bestall, JC;Paul, EA;Wedzicha, JA
通讯作者：
Wedzicha, JA