Cardiopulmonary work up of patients with and without fatigue 6 months after COVID-19

The pathogenesis of post-COVID-19 symptoms remains incompletely understood. Therefore, we aimed to determine cardiopulmonary limitations six months after surviving COVID-19 using pulmonary function tests (PFTs), echocardiographic studies to the point of analyses of global-longitudinal-strain (GLS), which describes the cycling myocardium deformation and provides better data on left ventricular (LV) dysfunction than LV ejection fraction (LVEF), and validated questionnaires. Overall, 60 consecutive hospitalized patients were included (61±2 years, 32% treated in the ICU). At follow-up (194±3 days after discharge), fatigue was the most prevalent symptom (28%). Patients with fatigue were more symptomatic overall and characterized by worse quality of life (QoL) scores compared to patients without fatigue (all p<0.05), mainly due to limited mobility and high symptom burden. While PFT variables and LVEF were normal in the vast majority (LVEF=52% (45%-52%)) of patients, GLS was significantly reduced (-15%(-18%_-14%)). However, GLS values were not different between patients with and without fatigue. In conclusion, fatigue was the most prevalent post-COVID-19 symptom in our cohort, which was associated with worse QoL mainly due to limited mobility and the high burden of concomitant symptoms. Patients showed a subtle myocardial dysfunction six months after surviving COVID-19, but this did not relate to the presence of fatigue.