Many long-haul COVID-19 patients have chronic fatigue syndrome and other breathing issues months after their initial COVID-19 diagnosis, according to a study published Nov. 29 in JACC: Heart Failure, which is the first of its kind to identify a correlation between long-haul COVID-19 and chronic fatigue syndrome.

Donna M. Mancini, MD, et al., looked at 41 patients (23 women, 18 men) with an age range of 23 to 69 years. Patients were referred to the prospective study from pulmonologists or cardiologists and all had normal pulmonary function tests, chest X-rays, chest CT scans and echocardiograms. Patients had been previously diagnosed with acute COVID-19 infection for a range of three to 15 months before undergoing the cardiopulmonary exercise test and continued to experience unexplained shortness of breath.

Before exercising, patients underwent interviews to assess for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). They were asked to estimate how much in the previous six months had fatigue reduced their activity at work, in their personal life and/or in school; and how often they had experienced sore throat, tender lymph nodes, headache, muscle aches, joint stiffness, unrefreshing sleep, difficulty concentrating or worsening of symptoms after mild exertion. ME/CFS was considered present if at least one of the first criteria were rated as being impacted substantially and at least four symptoms in the second criteria were rated as moderate or greater. Almost half (46%) of patients met the criteria for ME/CFS.

Patients while connected to an electrocardiogram, pulse oximeter and blood pressure cuff, were seated on a stationary bicycle and used a disposable mouthpiece for measurement of expired gases and other ventilatory parameters. After a brief rest period, the patients began exercises which increased in difficulty by 25 watts every three minutes. Peak oxygen consumption (VO₂), CO₂ production and ventilatory rate, and volume were measured.

Results showed almost all the patients (88%) exhibited dysfunctional breathing. Patients also had low CO₂ values at rest and with exercise, suggesting chronic hyperventilation. In addition, most of the patients (58%) had evidence of circulatory impairment to peak exercise performance from either cardiac dysfunction and/or abnormal pulmonary or peripheral perfusion.

“These findings suggest that in a subgroup of long haulers, hyperventilation and/or dysfunctional breathing may underlie their symptoms. This is important as these abnormalities may be addressed with breathing exercises or ‘retraining,’” said Mancini.

There are several limitations to this study. This is a small, single-center observational study. A selection bias may have occurred as the researchers studied patients with predominantly unexplained dyspnea. Correlation of the findings to lung and cardiac imaging also needs to be performed.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Acute Heart Failure, Computed Tomography, Nuclear Imaging, Exercise, Sleep Apnea, Sports and Exercise and ECG and Stress Testing, Sports and Exercise and Imaging

Keywords: Perfusion, Lymph Nodes, Pharyngitis, Sleep, Tomography, X-Ray Computed, Heart Diseases, Headache, Pain, Respiration, Electrocardiography, Heart Failure, Lung, Dyspnea, Oxygen Consumption, Breathing Exercises, Exercise, COVID-19, Blood Pressure, Bicycling, Physical Exertion, Selection Bias, X-Rays, Cardiologists, Pulmonologists, Hyperventilation, Exercise Test, Prospective Studies, Fatigue Syndrome, Chronic

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