Background:
Although post-COVID-19 condition is associated with impaired cardiopulmonary functional capacity and symptom burden, longitudinal assessments combining exercise testing, cardiac imaging, and patient-reported data remain scarce.
Methods:
Following confirmed COVID-19, consecutive patients with cardiopulmonary symptoms persisting ≥3 months were prospectively evaluated at the Ulm University Post COVID Outpatient Clinic. Patients with findings suggestive of cardiopulmonary disease underwent a combination of pulmonary function testing (PFT), cardiopulmonary exercise testing (CPET), and cardiac magnetic resonance (CMR) imaging. Physical (PCS) and mental health status (MCS) scores were obtained using the Short Form-36 questionnaire. After 2 years, follow-up assessment with PFT, CPET, and CMR was repeated in individuals with baseline abnormalities or ongoing symptoms.
Results:
A total of 119 patients completed PFT, CPET, and CMR. Median age was 54 years [IQR 39–61], 63% were female, and mean body mass index was 25.8 ± 4.5 kg/m². Median time from SARS-CoV-2 infection to evaluation was 153 days [IQR 113–219]. At baseline, reduced diffusing capacity with a DLCO < 80% predicted was found in 41.7%, reduced peak oxygen uptake with a VO₂peak < 80% predicted in 38.0%, and CMR abnormalities based on tissue characterization of T1, T2, ECV, LGE, and mapping in 8.7% of patients. VO₂peak was reduced in the lowest PCS tertile (20.7 [IQR 18.8–24.4] vs. 27.8 [IQR 21.6–31.2]mL/kg/min, p = 0.002). Similarly, patients in the lowest MCS and PCS tertiles exhibited lower DLCO (p = 0.024, p = 0.036), whereas no significant differences in CMR abnormalities were observed across MCS or PCS tertiles (2.8 vs. 11.1%, p = 0.164, and 5.6 vs. 13.9%, p = 0.233). At 2-year follow-up (n = 36), absolute left and right ventricular global longitudinal strain improved (14.3 [IQR 12.6–15.8] vs. 16.3 [IQR 13.8–17.6]%, p < 0.001, and 21.0 ± 3.7 vs. 23.3 ± 4.0%, p = 0.002). VO₂peak increased from 81.5 [IQR 76.3–105.8] to 98.0 [IQR 81.0–116.5]% (p < 0.001), while peak alveolar–arterial oxygen gradient declined from 27.7 ± 13.0 to 23.4 ± 12.4 mmHg (p < 0.001). The proportion of patients with NYHA class III/IV decreased from 25.0% to 5.6% (p = 0.039).
Conclusions:
In post-COVID-19 condition, cardiopulmonary impairment consistent with reduced patient-reported health status was observed 6 months after infection, with 2-year follow-up suggesting partial cardiopulmonary and clinical recovery.
