Diagnostic evaluation and cardiopulmonary exercise test findings in young athletes with persistent symptoms following COVID-19

Abstract

ObjectivesPersistent or late-onset cardiopulmonary symptoms following COVID-19 may occur in athletes despite a benign initial course. We examined the yield of cardiac evaluation, including cardiopulmonary exercise testing (CPET), in athletes with cardiopulmonary symptoms after COVID-19, compared CPETs in these athletes and those without COVID-19 and evaluated longitudinal changes in CPET with improvement in symptoms.MethodsThis prospective cohort study evaluated young (18–35 years old) athletes referred for cardiopulmonary symptoms that were present>28 days from COVID-19 diagnosis. CPET findings in post-COVID athletes were compared with a matched reference group of healthy athletes without COVID-19. Post-COVID athletes underwent repeat CPET between 3 and 6 months after initial evaluation.ResultsTwenty-one consecutive post-COVID athletes with cardiopulmonary symptoms (21.9±3.9 years old, 43% female) were evaluated 3.0±2.1 months after diagnosis. No athlete had active inflammatory heart disease. CPET reproduced presenting symptoms in 86%. Compared with reference athletes (n=42), there was similar peak VO2 but a higher prevalence of abnormal spirometry (42%) and low breathing reserve (42%). Thirteen athletes (62%) completed longitudinal follow-up (4.8±1.9 months). The majority (69%) had reduction in cardiopulmonary symptoms, accompanied by improvement in peak VO2 and oxygen pulse, and reduction in resting and peak heart rate (all p<0.05).ConclusionDespite a high burden of cardiopulmonary symptoms after COVID-19, no athlete had active inflammatory heart disease. CPET was clinically useful to reproduce symptoms with either normal testing or identification of abnormal spirometry as a potential therapeutic target. Improvement in post-COVID symptoms was accompanied by improvements in CPET parameters.

Persistent symptoms in athletes following COVID-19: time to take a breath in the search for answers?

“…As such, abnormalities in gas transfer and lung volumes are typically found, and impaired airflow is less commonly seen 9. The findings described by Moulson et al ,5 however, suggest that perhaps an alternative perspective is needed in non-hospitalised patients, with mild disease at onset but persisting pulmonary symptoms. The development of asthma-type symptoms, with airway hyper-responsiveness following viral infection, is a recognised phenomenon and targeted treatment, in this context, may enhance recovery.…”

“…A welcome addition to the published body of work is the paper by Moulson and colleagues,5 providing novel insight regarding the recovery of athletes with persistent symptoms. More precisely, the study addressed a vexing question for many clinicians of how to determine the cause of persistent cardiopulmonary symptoms following COVID-19 in athletic individuals.…”

“…In the general population with persistent or long-COVID symptoms, CPET studies have revealed disparate results, with some revealing a high prevalence of hyperventilation±breathing pattern irregularities,7 while others highlight issues in peripheral muscular oxygen extraction 8. In athletes with persistent cardiopulmonary symptoms, Moulson et al 5 found that CPET results were generally reassuring; despite nearly all subjects developing symptoms during testing, there were no contemporaneous cardiac abnormalities detected.…”

“…What is the cause of persistent cardiopulmonary symptoms in athletes following COVID-19? An intriguing finding from the Moulson study5 is the high prevalence of abnormalities detected on spirometry. Spirometry, a widely available and simple test of pulmonary function, revealed that approximately one-third of the cohort had evidence of airflow obstruction and many had a reduced breathing reserve at peak exercise.…”

“…Irrespective of whether further outbreaks or new variants of SARS-CoV-2 occur, SEM clinicians will continue to be faced with the challenge of tackling the 3Rs when they assess athletes with an acute respiratory illness. Studies such as that reported by Moulson and colleagues5 provide some initial evidence to inform management but leave many questions unanswered and in need of further research.…”