TY - JOUR T1 - Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19. AU - Cassar,Mark Philip, AU - Tunnicliffe,Elizabeth M, AU - Petousi,Nayia, AU - Lewandowski,Adam J, AU - Xie,Cheng, AU - Mahmod,Masliza, AU - Samat,Azlan Helmy Abd, AU - Evans,Rachael A, AU - Brightling,Christopher E, AU - Ho,Ling-Pei, AU - Piechnik,Stefan K, AU - Talbot,Nick P, AU - Holdsworth,David, AU - Ferreira,Vanessa M, AU - Neubauer,Stefan, AU - Raman,Betty, Y1 - 2021/10/20/ PY - 2021/07/28/received PY - 2021/09/25/revised PY - 2021/09/27/accepted PY - 2021/10/26/pubmed PY - 2021/10/26/medline PY - 2021/10/25/entrez KW - CMR KW - COVID-19 KW - CPET KW - SARS-CoV-2 KW - long COVID SP - 101159 EP - 101159 JF - EClinicalMedicine JO - EClinicalMedicine VL - 41 N2 - BACKGROUND: 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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: 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. SN - 2589-5370 UR - https://www.unboundmedicine.com/medline/citation/34693230/Symptom_Persistence_Despite_Improvement_in_Cardiopulmonary_Health___Insights_from_longitudinal_CMR_CPET_and_lung_function_testing_post_COVID_19_ DB - PRIME DP - Unbound Medicine ER -