Post COVID symptoms of fatigue or dyspnea in young patients are not related to impaired aerobic capacity measured be cardiopulmonary exercise testing

Background Up to 5-10% of patients (pts) report long-term cardiac symptoms associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aim To evaluate by cardiopulmonary exercise testing (CPET) pts with laboratory confirmed SARS-CoV-2 infection who reported fatigue or dyspnea symptoms 3 months after infection. Methods Pts hospitalization data, demographics, severity of COVID-19 disease and comorbidities were collected. Evidence of cardiac involvement during hospitalization was documented. All pts underwent an extensive clinical protocol with biomarkers, electrocardiography, 2D echocardiography, 24 hour Holter monitoring and a treadmill CPET. Results The cohort consisted of 85 pts (mean age 44 ± 8 yrs): 55 hospitalized pts (mean hospitalization 11.8 ± 4.3 days) and 30 non-hospitalized pts. Five percent of the cohort had evidence of troponin rise upon infection. A relevant cardiac diagnosis was identified in 48% of the cohort. The dominant diagnoses were cardiomyopathy (18%) and healed myocarditis (13%) followed by diastolic heart failure (5%), pulmonary hypertension (4%) and cardiac arrhythmias (3%). Fifty eight (68%) pts of the cohort (mean age 43±8) underwent a treadmill CPET, 25 (43%) of them complaining of fatigue and (28) 57% of effort dyspnea at presentation. However, they showed an overall satisfactory exercise capacity on CPET by achieving (mean 88±15 %) of the max predicted pVO2 with achieved VE/VCO2 also within normal range (mean 31±4). Conclusions Cardiac involvement is identified in almost half of young patients with long-Covid symptoms of fatigue or dyspnea who were referred to a tertiary cardiac center. However, despite symptoms their aerobic capacity objectively measured by CPET was not impaired.