Evaluation of myocardial work and exercise capacity in patients recovered from the severe form of COVID-19.

Background: The impact of COVID-19 goes beyond its acute form and can lead to the persistence of symptoms and the emergence of systemic disorders, defined as long-term COVID. Methods: We performed a cross-sectional study that included patients over 18 years of age who recovered from the severe form of COVID-19 at least 60 days after their discharge. Patients and controls were enrolled to undergo transthoracic echocardiography (TTE) using a more sensitive tool, myocardial work, in combination with cardiopulmonary exercise testing (CPET). Results: A total of 52 patients and 31 controls were enrolled. Significant differences were observed in ejection fraction (LVEF; 62 ± 7 vs. 66 ± 6 %; p = 0.007), global longitudinal strain (LVGLS; -18.7 ± 2.6 vs. -20.4 ± 1.4 %; p = 0.001), myocardial wasted work (GWW; 152 ± 81 vs. 101 ± 54 mmHg; p = 0.003), and myocardial work efficiency (GWE; 93 ± 3 vs. 95 ± 2 %; p = 0.002). We found a significant difference in peak VO2 (24.4 ± 5.4 vs. 33.4 ± 8.8 mL/kg/min; p < 0.001), heart rate (160 ± 14 vs. 176 ± 11 bpm; p < 0.001), ventilation (84.6 ± 22.6 vs. 104.9 ± 27.0 L/min; p < 0.001), OUES% (89 ± 16 vs. 102 ± 22 %; p = 0.002), T ½ (120.3 ± 32 vs. 97.6 ± 27 s; p = 0.002) and HRR at 2 min (-36 ± 11 vs. -43 ± 13 bpm; p = 0.010). Conclusion: Our findings revealed an increased wasted work, with lower myocardial efficiency, significantly reduced aerobic exercise capacity, and abnormal heart rate response during recovery, which may be related to previously described late symptoms. The reduction in functional capacity during physical exercise is partly associated with a decrease in resting myocardial work efficiency. These findings strongly indicate the need to determine whether these manifestations persist in the long term and their impact on cardiovascular health and quality of life in COVID-19 survivors.

Longitudinal strain and myocardial work in symptomatic patients having recovered from COVID-19 and possible associations with the severity of the disease.

COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.

Efeito de dois ritmos de dança de salão na resposta da pressão arterial pós-exercício: uma comparação entre o samba e o bolero / Effect of two rhythms of ballroom dance on post exercise blood pressure response: a comparison between samba and bolero

A dança de salão pode representar uma alternativa de exercício físico para controle da pressão arterial (PA), tanto de forma crônica como aguda. O objetivo foi avaliar e comparar a resposta da PA após uma sessão de samba da gafieira e após uma sessão de bolero. Dezenove mulheres não hipertensas (21,9 ± 3,4 anos e IMC de 21,5 ± 2,5 kg/m2) praticantes da dança de salão avançada foram submetidas a duas sessões experimentais de dança de salão com dois ritmos, bolero e samba de gafieira, sendo avaliada a frequência cardíaca (FC) e a pressão arterial (PA) de repouso, durante as sessões (apenas FC) e a cada 10 min durante 60 min após as sessões. Durante as sessões, a FCmédia atingida no bolero foi 145 ± 15 bpm (78 ± 8 %FCmax) e no samba foi 178 ± 13 bpm (92 ± 6 %FCmax), representando intensidade moderada e vigorosa, respectivamente. No ritmo bolero, após 10 min do final da sessão, a pressão arterial sistólica (PAS) já apresentou valores semelhantes (p > 0,05) ao re-pouso (112,0 ± 12,9 mmHg), sendo mantidos até 60 min após a dança. No samba, a PAS entre os 30 a 60 min foi menor (p < 0,05) que em repouso (114,0 ± 13,0 mmHg), evidenciando hipotensão pós-exercício. Não foram observadas reduções da pressão arterial diastólica após as danças. O ritmo mais intenso, representado pelo samba, induziu hipotensão pós-exercício, o que não ocorreu com o ritmo bolero, que apresentou apenas uma diminuição do trabalho do miocárdio.

The ballroom dance could represent an alternative exercise to both acute and chronic control of blood pressure (BP). The objective was to evaluate and to compare the BP response after a single session of samba da gafieira and single session of bolero. Nineteen advanced ballroom dancers and normotensive women (21.9 ± 3.4 years and BMI of 21.5 ± 2.5 kg/m2) performed two experimental sessions of ballroom dancing with two rhythms, bolero and samba de gafieira. Heart rate (HR) and BP were measured before and every 10 min during 60 min following the experimental sessions. HR was also measured during the sessions. Mean HR was 145 ± 15 bpm (78 ± 8 %FCmax) and 178 ± 13 bpm (92 ± 6 %FCmax) for bolero and samba, respectively. This means that the intensity of bolero was moderate and samba was vigorous. After 10 min of bolero and at the end of the evaluation (60 min), systolic blood pressure (SBP) was not different (p > 0.05) from rest (112.0 ± 12.9 mmHg). SBP between the 30th and 60th min following the samba session was different (p < 0.05) from rest (114.0 ± 13.0 mmHg), showing post-exercise hypotension. Diastolic blood pressure did not present reduction following the experimental sessions. The most intense rhythm, representing by samba, elicited post-exercise hypotension, which did not occur with the bolero rhythm. Bolero only presented a decrease in myocardial work.