Cardiovascular evaluation with exercise testing using face mask during the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic is associated with more than 127 million of infected people and 2.7 million deaths in the world. However, cardiovascular diseases are still a worldwide main health problem. Patients are afraid to go to the hospital because of the risk of being infected with SARS-COV2. In particular, exercise testing (ET) has been underused, due to the fear of the airborne aerosol generation. There are cardiology centers performing ET that ask patient to wear a mask, although its consequences are not yet well known and there is only preliminary information of its use in patients with heart disease. Purpose Our objective was to evaluate the ergometric behavior of patients that performed an ET wearing a mask during the COVID-19 pandemic (COVID-G) and compare them with patients in the pre-pandemic period. Methods A cohort of patients who underwent an ET from march to december 2020 was compared with patients that performed an ET between march and december 2019. Because of COVID-19 preventive restrictions, we used a larger and highly ventilated room to perform ET. The antisepsis protocol was performed (room and equipment) and healthcare crew always wore high efficiency masks and ocular protection. All patients studied in 2020, must had succeeded a biological triage, and wore a mask throughout the ET. Variables are presented as frequency (percentage), mean (standard deviation) or median (interquartile interval) according to variable-type and distribution. Chi-square test, Student's t test or the Wilcoxon rank test were used as appropriate. All p values less than 0.05 were considered stochastically significant. Results A total of 361 stress tests were studied, where 209 (58%) belonged to pre-pandemic group and 152 (42%) to COVID-G. Eighty-one percent were male, the mean age was 46±20 years and the most prevalent diagnosis was coronary heart disease (61%). There were no statistically diferences between groups according to demographic variables. No mayor adverse outcome occurred during ET. The most common reason of exercise suspension in COVID-G was dyspnea compared to pre-pandemic studies: 117 (77%) vs 8 (4%), OR= 6.3 (95% CI, 4.6 to 8.6, p<0.001). Heart rate behavior along ET did not show significant differences between groups. Nevertheless, blood pressure levels were significantly higher in COVID-G patients than those in pre-pandemic group. Exertional blood pressure index was higher in the COVID-G (1.31±0.24 vs 1.26±0.2, p<0.05) than the pre-pandemic group. On the other side, maximal exercise tolerance (METs) did not show significant differences between groups (p=ns). Conclusions Exercise testing can be safely performed in patients with cardiovascular disease while wearing masks. In the COVID period, a significantly lower number of ET was performed. In addition, ET performance with mask was associated with higher values of systolic blood pressure and an increased number of tests suspended due to dyspnea. FUNDunding Acknowledgement Type of funding sources: None. Blood pressure behavior Ergometric performance

A Systematic Review of Whether the Use of N95 Respirator Masks Decreases the Incidence of Cardiovascular Disease in the General Population

“…In this review, one particular study demonstrated that at rest, a mild increase in heart rate by 5.6% was noted whilst wearing an N95 respirator in comparison to not wearing a mask [ 8 ]. These findings were replicated in other studies such as by Ilarraza-Lomelí et al [ 12 ]. However, both authors commented that the results were not statistically significant to draw the conclusion that the elevated heart rate was an effect of the N95 mask.…”

“…One of these studies compared exercise tests performed prior to the pandemic without any mask against those performed during the pandemic whilst using an N95 mask [12]. A key finding from this cross-sectional study was that there was an increase in the number of exercise tests that were suspended due to dyspnoea compared to those tests conducted during the pandemic with an N95 mask [12]. This is a very relevant finding since it illustrates that N95 respirators can potentially lead to greater levels of shortness of breath.…”

“…Multiple studies have shown that using an N95 respirator leads to greater rates of dyspnoea. One of these studies compared exercise tests performed prior to the pandemic without any mask against those performed during the pandemic whilst using an N95 mask [ 12 ]. A key finding from this cross-sectional study was that there was an increase in the number of exercise tests that were suspended due to dyspnoea compared to those tests conducted during the pandemic with an N95 mask [ 12 ].…”