{"doi":"10.1093/infdis/jiad131","title":"Reduced Exercise Capacity, Chronotropic Incompetence, and Early Systemic Inflammation in Cardiopulmonary Phenotype Long Coronavirus Disease 2019","abstract":"BACKGROUND: Mechanisms underlying persistent cardiopulmonary symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (postacute sequelae of coronavirus disease 2019 [COVID-19; PASC] or \"long COVID\") remain unclear. This study sought to elucidate mechanisms of cardiopulmonary symptoms and reduced exercise capacity. METHODS: We conducted cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring among adults >1 year after SARS-CoV-2 infection, compared those with and those without symptoms, and correlated findings with previously measured biomarkers. RESULTS: Sixty participants (median age, 53 years; 42% female; 87% nonhospitalized; median 17.6 months after infection) were studied. At CPET, 18/37 (49%) with symptoms had reduced exercise capacity (<85% predicted), compared with 3/19 (16%) without symptoms (P = .02). The adjusted peak oxygen consumption (VO2) was 5.2 mL/kg/min lower (95% confidence interval, 2.1-8.3; P = .001) or 16.9% lower percent predicted (4.3%-29.6%; P = .02) among those with symptoms. Chronotropic incompetence was common. Inflammatory markers and antibody levels early in PASC were negatively correlated with peak VO2. Late-gadolinium enhancement on CMR and arrhythmias were absent. CONCLUSIONS: Cardiopulmonary symptoms >1 year after COVID-19 were associated with reduced exercise capacity, which was associated with earlier inflammatory markers. Chronotropic incompetence may explain exercise intolerance among some with \"long COVID.\"","journal":"The Journal of Infectious Diseases","year":2023,"id":324291,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":34,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9279,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":228705,"name":"Michael J. 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Goldberg","orcid":"0000-0002-8642-1468","position":9,"is_corresponding":false},{"id":71690,"name":"Rebecca Hoh","orcid":"0000-0001-5112-4220","position":10,"is_corresponding":false},{"id":618498,"name":"Ahmed Chenna","orcid":"0000-0001-6201-2494","position":11,"is_corresponding":false},{"id":618499,"name":"Brandon C. Yee","orcid":"0000-0003-4649-7975","position":12,"is_corresponding":false},{"id":618500,"name":"John Winslow","orcid":"0000-0003-2701-2493","position":13,"is_corresponding":false},{"id":461185,"name":"Christos J. Petropoulos","orcid":"0000-0001-5496-8090","position":14,"is_corresponding":false},{"id":252180,"name":"J. Daniel Kelly","orcid":"0000-0002-7616-0321","position":15,"is_corresponding":false},{"id":316641,"name":"David V. Glidden","orcid":"0000-0001-5888-1419","position":16,"is_corresponding":false},{"id":239686,"name":"Timothy J. Henrich","orcid":"0000-0002-6684-0622","position":17,"is_corresponding":false},{"id":239684,"name":"Jeffrey N. 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