Cardiopulmonary Exercise Test in the Detection of Unexplained Post-COVID-19 Dyspnea

In this recent report published in International Heart Journal, authors detail a 39-year-old male with excessive body weight and a history of borderline values of arterial hypertension without therapy, who was mainly complaining of progressive dyspnea after being diagnosed with mild COVID-19.

 

According to the recent guidelines on the holistic assessment and management of patients who had COVID-19, all preferred diagnostic procedures, including multidetector computed tomography (CT), CT pulmonary angiogram, and echocardiography, should be conducted. However, in this patient, no underlying cardiopulmonary disorder has been established.

 

Further investigations were performed considering that cardiopulmonary exercise test (CPET) represents a reliable diagnostic tool for patients with unexplained dyspnea.

 

CPET revealed reduced exercise capacity (peak VO2 68% of predicted), impaired ventilatory efficiency (VE/VCO2 slope), early O2 pulse (VO2/HR) plateau, and exaggerated blood pressure response (220/110 mmHg), indicating a potential underlying diastolic dysfunction. This finding was crucial in guiding further therapy.

Interestingly, the authors suggest that before COVID infection, the patient may have had subclinical and asymptomatic heart failure with preserved ejection fraction (HFpEF), which was triggered by COVID and clinically manifested.

This case highlights the importance of CPET in identifying hidden cardiopulmonary abnormalities contributing to post-COVID-19 dyspnea and provides further evidence that CPET should be used as a front-line test rather than an afterthought.

  

In conclusion, the CPET may be a useful method for resolving these diagnostic dilemmas, as in this case.