{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:50:35Z","timestamp":1791960635021,"version":"4.3.4"},"reference-count":89,"publisher":"Wiley","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Long COVID is frequently associated with persistent exercise intolerance, although the relative contributions of peripheral vascular dysfunction and myocardial function remain unclear. We investigated whether persistent endothelial dysfunction and altered myocardial work (MW) contribute to exercise intolerance approximately 3\u2009years after SARS\u2010CoV\u20102 infection. This case\u2013control study included adults with Long COVID (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200910) and controls (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200911) who underwent cardiopulmonary exercise testing (CPET), transthoracic echocardiography with global longitudinal strain (GLS) and MW analysis, and brachial artery flow\u2010mediated dilation (FMD) with hyperemic shear assessment. Compared with controls, Long COVID participants exhibited lower peak V\u0307O\n                    <jats:sub>2<\/jats:sub>\n                    (19.6\u2009\u00b1\u20092.5 vs. 24.3\u2009\u00b1\u20096.5\u2009mL\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    \u00b7min\n                    <jats:sup>\u22121<\/jats:sup>\n                    ,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04), percent\u2010predicted peak V\u0307O\n                    <jats:sub>2<\/jats:sub>\n                    (61.1\u2009\u00b1\u20098.3 vs. 77.0\u2009\u00b1\u200914.2%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006), and V\u0307O\n                    <jats:sub>2<\/jats:sub>\n                    at first ventilatory threshold (11.0\u2009\u00b1\u20091.4 vs. 13.7\u2009\u00b1\u20093.8\u2009mL\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    \u00b7min\n                    <jats:sup>\u22121<\/jats:sup>\n                    ,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04). Conventional echocardiographic parameters and MW indices did not differ between groups (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). In contrast, endothelial function was impaired in the Long COVID group, with lower FMD (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), peak shear rate (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01), AUCSR (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04), and AUCmax (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). FMD correlated positively with exercise capacity in the Long COVID group (peak V\u0307O\n                    <jats:sub>2<\/jats:sub>\n                    :\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.68,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03;percent\u2010predicted peak V\u0307O\n                    <jats:sub>2<\/jats:sub>\n                    :\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.64,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04). In conclusion, 3\u2009years after infection, Long COVID remains characterized by endothelial dysfunction and blunted hyperemic shear despite preserved MW, supporting a predominantly peripheral vascular basis for persistent exercise intolerance.\n                  <\/jats:p>","DOI":"10.14814\/phy2.71103","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:34:04Z","timestamp":1790735644000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent endothelial dysfunction is associated with exercise intolerance in adults despite preserved myocardial work 3\u2009years after SARS\u2010CoV\u20102 infection"],"prefix":"10.14814","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0986-6399","authenticated-orcid":false,"given":"Carla Cristina","family":"de Ara\u00fajo Alves","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8731-689X","authenticated-orcid":false,"given":"C\u00e1ssia da Luz","family":"Goulart","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"},{"name":"Internal Medicine Department Federal University of Rio Grande Do Sul (UFRGS)  Porto Alegre RS Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0953-1321","authenticated-orcid":false,"given":"Luciana","family":"D'\u00c1vila","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9293-4430","authenticated-orcid":false,"given":"Beatriz Helena Ernesto","family":"de Souza Silva","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3149-377X","authenticated-orcid":false,"given":"Igor Machado","family":"Alves","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1072-196X","authenticated-orcid":false,"given":"Brena Vit\u00f3ria Souza","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1650-2927","authenticated-orcid":false,"given":"Claudia","family":"Conde","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2357-5176","authenticated-orcid":false,"given":"Ricardo","family":"Stein","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Federal University of Rio Grande Do Sul (UFRGS)  Porto Alegre RS Brazil"},{"name":"Exercise Cardiology Research Group Hospital de Cl\u00ednicas de Porto Alegre (CardioEx\u2010HCPA)  Porto Alegre RS Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9560-6520","authenticated-orcid":false,"suffix":"Jr.","given":"Gerson","family":"Cipriano","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Exercise Physiology, FCE University of Bras\u00edlia (UnB)  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14222499"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.70027"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvaa085"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11051452"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2136403"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells9071652"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X13508446"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00412-3"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2020.117723"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.70216"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181e52e69"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2020.05.013"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.15575"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000928"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2023.03.022"},{"key":"e_1_2_11_17_1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J.","year":"1988"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2023.05.005"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001348"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13144090"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-023-03042-2"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-022-00846-2"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjpt.2023.100503"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S282710"},{"key":"e_1_2_11_25_1","doi-asserted-by":"crossref","unstructured":"Durstenfeld M. S. Peluso M. J. Kaveti P. Hill C. Li D. Sander E. Swaminathan S. Arechiga V. M. Lu S. Goldberg S. A. Hoh R. Chenna A. Yee B. C. Winslow J. W. Petropoulos C. J. Kelly J. D. Glidden D. V. Henrich T. J. Martin J. N. \u2026Hsue P. Y.(2023).Reduced exercise capacity chronotropic incompetence and early systemic inflammation in cardiopulmonary phenotype Long COVID.medRxiv. 2022.05.17.22275235.","DOI":"10.1101\/2022.05.17.22275235"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.36057"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19159340"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-021-02356-3"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.122.19958"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahjo.2026.100734"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-021-01895-6"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-24-00464"},{"key":"e_1_2_11_33_1","article-title":"Long COVID prevalence and risk factors: A systematic review and meta\u2010analysis of prospective cohort studies","volume":"13","author":"Halas R. G.","year":"2025","journal-title":"Biomedicine"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvac095"},{"key":"e_1_2_11_35_1","first-page":"467","article-title":"Cardiopulmonary exercise test: Background, applicability and interpretation","volume":"107","author":"Herdy A. H.","year":"2016","journal-title":"Arquivos Brasileiros de Cardiologia"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15754"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2451"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.15940"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.70535"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.15420\/usc.2024.37"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-021-00495-0"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-1790603"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.2217\/fca-2022-0017"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-8-115"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1561946"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00291.2022"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12081837"},{"key":"e_1_2_11_49_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-070113","article-title":"Exploratory analyses in aetiologic research and considerations for assessment of credibility: Mini\u2010review of literature","volume":"377","author":"Luijken K.","year":"2022","journal-title":"BMJ"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jey188"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-082441"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.36660\/abc.20220150"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000690"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.667721"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2021.106469"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026571"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00055.2025"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13144005"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004511"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2024.104285"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2021-001121"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.70429"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12980"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs016"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v10.i3.762"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0318707"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1271863"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-026-41182-2"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1177\/20503121241296701"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00734.2021"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-85221-w"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.08.010"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.780872"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms27010433"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2022.2081454"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)01054-8"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz350"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.4386"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.3390\/biology12030370"},{"key":"e_1_2_11_80_1","article-title":"The impact of metabolic syndrome and obesity on the evolution of diastolic dysfunction in apparently healthy patients suffering from post\u2010COVID\u201019 syndrome","volume":"10","author":"Tudoran C.","year":"2022","journal-title":"Biomedicine"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0257607"},{"key":"e_1_2_11_82_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.11.003"},{"key":"e_1_2_11_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa162"},{"key":"e_1_2_11_85_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.03.012"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocmr.2025.101890"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10456-023-09878-5"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01689-3"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1450470"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2025.133321"}],"container-title":["Physiological Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/pdf\/10.14814\/phy2.71103","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/full-xml\/10.14814\/phy2.71103","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/pdf\/10.14814\/phy2.71103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:40:26Z","timestamp":1791960026000},"score":1,"resource":{"primary":{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/10.14814\/phy2.71103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":89,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.14814\/phy2.71103"],"URL":"https:\/\/doi.org\/10.14814\/phy2.71103","archive":["Portico"],"relation":{},"ISSN":["2051-817X","2051-817X"],"issn-type":[{"value":"2051-817X","type":"print"},{"value":"2051-817X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-07-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71103"}}