RT Journal Article SR Electronic T1 Exercise intolerance in post-COVID19 survivors after hospitalization JF ERJ Open Research JO erjor FD European Respiratory Society SP 00538-2022 DO 10.1183/23120541.00538-2022 A1 Mariana L Lafetá A1 Vitor C Souza A1 Thaís C F Menezes A1 Carlos G Y Verrastro A1 Frederico J Mancuso A1 André Luis P Albuquerque A1 Suzana E Tanni A1 Meyer Izbicki A1 Júlio P Carlstron A1 Luiz Eduardo Nery A1 Rudolf K F Oliveira A1 Priscila A Sperandio A1 Eloara V M Ferreira YR 2023 UL http://openres.ersjournals.com/content/early/2023/03/02/23120541.00538-2022.abstract AB Rationale Post-COVID19 survivors frequently have dyspnea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID19 patients remain incompletely characterized.Objectives To clarify the mechanisms of exercise intolerance in post-COVID19 survivors after hospitalization.Methods Prospective study evaluated consecutive patients previously hospitalized due to moderate-to-severe/critical COVID19. Within 90±10 days (mean±sd) of COVID19 acute symptoms onset, patients underwent a comprehensive cardiopulmonary assessment, including a cardiopulmonary exercise testing with earlobe arterialized capillary blood gas analysis.Measurements and Main Results Eighty-seven patients were evaluated, their mean±sd peak oxygen consumption were 19.5±5.0 ml kg−1·min−1, and the tertiles were: ≤17.0, 17.1–22.2 and ≥22.3 ml kg−1·min−1. Hospitalization severity was similar among the three groups; however, at the follow-up visit, they reported a greater sensation of dyspnea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with peak oxygen consumption >17 ml kg−1·min−1. By multivariate logistic regression analysis (ROC curve analysis) adjusted for age, sex and pulmonary embolism, a peak dead space fraction of tidal volume ≥29 and a resting forced vital capacity ≤80%predicted were independent predictors of reduced peak oxygen consumption.Conclusions Exercise intolerance in the post-COVID19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Mariana L Lafetá has nothing to disclose.Conflict of interest: Vitor C Souza has nothing to disclose.Conflict of interest: Thaís C F Menezes has nothing to disclose.Conflict of interest: Carlos G Y Verrastro has nothing to disclose.Conflict of interest: Frederico J Mancuso has nothing to disclose.Conflict of interest: André Luis p Albuquerque has nothing to disclose.Conflict of interest: Suzana E Tanni reports be President of Sao Paulo Thoracic Society, outside the submitted work.Conflict of interest: Meyer Izbicki has nothing to disclose.Conflict of interest: Júlio p Carlstron has nothing to disclose.Conflict of interest: Luiz Eduardo Nery has nothing to disclose.Conflict of interest: Rudolf K F Oliveira report grants from National Council for Scientific and Technological Development (CNPq, Brazil, grant 313284/2021-0) and personal fees from Janssen Brazil, outside the submitted work.Conflict of interest: Priscila A Sperandio has nothing to disclose.Conflict of interest: Eloara V M Ferreira reports speaker fees from Janssen, and personal fees from Aché, Aztrazeneca, Bayer, Boeringer, GSK, Novo Nordisk, Jassen-Cilag J&J, Zambon, outside the submitted work.