Symptom Persistence Despite Improvement in Cardiopulmonary Health – Insights from longitudinal CMR, CPET and lung function testing post-COVID-19

  1. Mark Philip Cassar
  2. Elizabeth M. Tunnicliffe
  3. Nayia Petousi
  4. Adam J. Lewandowski
  5. Cheng Xie
  6. Masliza Mahmod
  7. Azlan Helmy Abd Samat
  8. Rachael A. Evans
  9. Christopher E. Brightling
  10. Ling-Pei Ho
  11. Stefan K. Piechnik
  12. Nick P. Talbot
  13. David Holdsworth
  14. Vanessa M. Ferreira
  15. Stefan Neubauer
  16. Betty Raman

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  1. Version published to 10.1016/j.eclinm.2021.101159
  2. ScreenIT

    SciScore for 10.1101/2021.08.03.21260940: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Study procedures: Informed consent was obtained from all patients.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using SPSS Version 27.0 (IBM, Armonk, NY, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Of importance, cardiopulmonary limitations were not felt to be the main driver of exercise intolerance by 6 months as reduced peak oxygen consumption was only seen in symptom-limited submaximal tests. Other CPET studies of COVID-19 patients have also demonstrated a high proportion of submaximal tests.30 In one study, direct assessment of maximum muscle strength using dominant leg extension independently predicted peak oxygen consumption in patients following COVID-19.7 Taken together, these findings strongly suggest that muscular conditioning and fitness are important determinants of exercise tolerance and highlight the role of dedicated rehabilitation in augmenting recovery. Postural orthostatic tachycardia and other manifestations of dysautonomia have frequently been described among patients post-COVID-19.31,32 Here, we showed that at 2-3 months, heart rate recovery, an indirect measure of autonomic health, was impaired in patients compared to controls.33 By six months, heart rate recovery improved, implying that dysautonomia may be transient and does spontaneously recover in some patients. An interesting observation from serial CPET assessments was that O2 pulse, a marker of exertional stroke volume, was reduced in patients at 2-3 months and normalized by 6 months. Reduced O2 pulse has also been observed in a recent study by Baratto et al.,34 where impaired tissue oxygen extraction has been implicated. Increased pulmonary vascular resistance (PVR) can also explain the redu...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04510025RecruitingCapturing MultiORgan Effects of COVID-19

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.08.03.21260940 on medRxiv