{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:43:43Z","timestamp":1793727823047,"version":"4.6.1"},"reference-count":35,"publisher":"European Respiratory Society (ERS)","issue":"1","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2023,12,4]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Post-acute sequelae of COVID-19 (PASC) affect a significant proportion of patients who have previously contracted SARS-CoV-2, with exertional intolerance being a prominent symptom. This study aimed to characterise the invasive haemodynamic abnormalities of PASC-related exertional intolerance using invasive cardiopulmonary exercise testing (iCPET).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design and intervention<\/jats:title><jats:p>55 patients were recruited from the Yale Post-COVID-19 Recovery Program, with most experiencing mild acute illness. Supine right heart catheterisation and iCPET were performed on all participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>The majority (75%) of PASC patients exhibited impaired peak systemic oxygen extraction (pEO<jats:sub>2<\/jats:sub>) during iCPET in conjunction with supranormal cardiac output (CO) (<jats:italic>i.e.<\/jats:italic>, PASC alone group). On average, the PASC alone group exhibited a \u201cnormal\u201d peak exercise capacity,<jats:italic>V\u2032<\/jats:italic><jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>(89\u00b118% predicted). \u223c25% of patients had evidence of central cardiopulmonary pathology (<jats:italic>i.e.<\/jats:italic>, 12 with resting and exercise heart failure with preserved ejection fraction (HFpEF) and two with exercise pulmonary hypertension (PH)). PASC patients with HFpEF (<jats:italic>i.e.<\/jats:italic>, PASC HFpEF group) exhibited similarly impaired pEO<jats:sub>2<\/jats:sub>with well compensated PH (<jats:italic>i.e.<\/jats:italic>, peak<jats:italic>V\u2032<\/jats:italic><jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>and CO &gt;80% respectively) despite aberrant central cardiopulmonary exercise haemodynamics. PASC patients with HFpEF also exhibited increased body mass index of 39\u00b17\u2005kg\u00b7m<jats:sup>\u22122<\/jats:sup>. To examine the relative contribution of obesity to exertional impairment in PASC HFpEF, a control group comprising obese non-PASC group (n=61) derived from a historical iCPET cohort was used. The non-PASC obese patients with preserved peak<jats:italic>V\u2032<\/jats:italic><jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>(&gt;80% predicted) exhibited a normal peak pulmonary artery wedge pressure (17\u00b114<jats:italic>versus<\/jats:italic>25\u00b16\u2005mmHg; p=0.03) with similar maximal voluntary ventilation (90\u00b112<jats:italic>versus<\/jats:italic>86\u00b110% predicted; p=0.53) compared to PASC HFpEF patients. Impaired pEO<jats:sub>2<\/jats:sub>was not significantly different between PASC patients who underwent supervised rehabilitation and those who did not (p=0.19).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study highlights the importance of considering impaired pEO<jats:sub>2<\/jats:sub>in PASC patients with persistent exertional intolerance unexplained by conventional investigative testing. Results of the current study also highlight the prevalence of a distinct high output HFpEF phenotype in PASC with a primary peripheral limitation to exercise.<\/jats:p><\/jats:sec>","DOI":"10.1183\/23120541.00714-2023","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T13:05:40Z","timestamp":1702645540000},"page":"00714-2023","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Differential cardiopulmonary haemodynamic phenotypes in PASC-related exercise intolerance"],"prefix":"10.1183","volume":"10","author":[{"given":"Peter A.","family":"Kahn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-8629","authenticated-orcid":false,"given":"Phillip","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9765-9885","authenticated-orcid":false,"given":"Paul M.","family":"Heerdt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5624-1274","authenticated-orcid":false,"given":"Inderjit","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2023,12,15]]},"reference":[{"key":"2024101712133140000_10.1.00714-2023.1","unstructured":"World Health Organization ( WHO) . 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