Table 7.
Studies addressing assessment of long COVID—Others
| Who (severity of acute COVID-19) | When | Findings | References | Newcastle–Ottawa score | |
|---|---|---|---|---|---|
| Cardiac | |||||
| Echocardiogram | Mild to moderate | 2–3 mo | Evidence is variable. Different rates of abnormal findings (diastolic dysfunction, systolic dysfunction, elevated pulmonary artery pressure with or without pericardial disease). Rates are higher in patients hospitalized for analysis or referred to cardiology for ongoing cardiac symptoms (25%–27.5% overall abnormal findings). In one study, EF was normal in a cohort of 215 patients, but left ventricular global longitudinal strain was reduced in 29%. | Tudoran et al., 2021 [65] Lewek et al., 2021 [64] Hayama et al., 2021 [66] |
4 5 5 |
| 6 mo | A study in health care workers found no difference between mild recovering patients and healthy controls. | Joy et al., 2021 [72] | 7 (case control) | ||
| Severe | 3–4 mo | High rates of diastolic dysfunction (55%). Lower rates of pericardial disease and pulmonary arterial hypertension and reduced left ventricular EF | Sonnweber et al., 2021 [67] | 5 | |
| Mixed patient population | Mixed follow-up (23–104 d) | Systematic review reporting reduced left ventricular EF in 0%–16%; left ventricular hypertrophy in 0%–0.5%; diastolic dysfunction in 0%–55%; pulmonary hypertension in 0%–10%; and pericardial effusion in 0%–6%. | Ramadan et al., 2021 [40] | AMSTAR grade: Low | |
| Cardiac MRI | Asymptomatic to mild | Postacute period | Abnormal MRI myocardial findings are common in the postacute period. A study of athletes showed abnormalities in 5 of 26 asymptomatic patients after mild disease (20%). In severe cases, abnormalities may be found in up to 70% of patients. No correlation was shown with ongoing symptoms. | Malek et al., 2021 [68] Pan et al., 2021 [69] |
3 6 |
| Severe one third | 2–3 mo | Cardiac involvement in 78%, with ongoing myocardial inflammation in 60% | Puntmann et al., 2020 [39] | 7 | |
| Moderate to severe | 3–4 mo | Findings suggestive of myocarditis (late gadolinium enhancement) in recovered patients were common in 26%–29% (13/50; 13/44) | Wang et al., 2021 [70] Raman et al., 2021 [63] Dennis et al., 2021 [71] |
6 6 6 |
|
| Mild | 6 mo | Study of health care workers at 6 mo showing complete resolution of cardiac MRI findings in all patients | Joy et al., 2021 [72] | 7 (case control) | |
| Mixed patient population | Mixed follow up (14–180 d) | Systematic review reporting increased T1 in 0%–73%; increased T2 in 0%–60%; late gadolinium enhancement (myocardial or pericardial) in 0%–46% and up to 100%. In four studies reporting formal diagnoses, myocarditis was reported in 0%–37%, myopericarditis in 0%–11%, pericarditis in 0%–3%, and myocardial infarction in 0%–2%. | Hassani et al., 2021 [73] Ramadan et al., 2021 [40] |
AMSTAR grade: Critically low | |
| Functional | |||||
| Functional (6MWT, STS, SPPB) | Hospitalized, mostly severe to critical disease | 1–12 mo | 6MWT and SPPB were moderately/severely impaired in comparison with expected ranges for age and sex. Impairment is mostly dependent on disease severity, and patients after severe disease had lower SPO2 after testing. | Truffaut et al., 2021 [42] Anastasio et al., 2021 [75] Bellan et al., 2021 [74] Guler et al., 2021 [50] Huang et al., 2020 [47] Shah et al., 2021 [77] van den Borst et al., 2020 [51] Jalušić Glunčić et al., 2021 [142] Cortés-Telles et al., 2021 [143] Baranauskas et al., 2021 [144] Betschart et al., 2021 [145] Jacobson et al., 2021 [146] Aiello et al., 2021 [147] Schandl et al., 2021 [148] Aranda et al., 2021 [149] Liao et al., 2021 [150] |
4 5 5 5 4 4 5 5 7 7 6 5 6 6 6 6 |
| Hospitalized | After discharge | STS was severely impaired in patients after discharge, correlated with post-effort dyspnoea and desaturation | Nunez Cortez et al., 2021 [151] | 4 | |
| Cardiopulmonary stress testing (CPET) | All degrees | 2–4 mo | Included individuals had relatively slightly lower than expected peak oxygen consumption (91.2% (19.4%)), lower probability of achieving anaerobic threshold, and higher probability of presenting symptoms during CPET. Compared with healthy controls, peak oxygen consumption was decreased (81%; SD: 23% of expected p < 0.0001). Of all recoverees, 28/51 (55%) had peak oxygen consumption <80% of predicted. Patients recovering from COVID-19 had symptoms associated with reduction in peak oxygen consumption; 8/71 (11%) had peak oxygen consumption <85% of predicted. Peak oxygen consumption is reduced to an average of 83% ± 15% of predicted. Exercise capacity is not associated with severity of COVID-19. Of the entire sample 6/31 (19%) had pulmonary-vascular limitations, 5/31 (16%) had pulmonary-mechanical limitations, 4/31 (13%) had deconditioning, and 1/31 (3%) had cardiac capacity limitation. Mean peak oxygen consumption was 73% of predicted. The main reason for dyspnoea is suspected to be muscular. |
Barbagelata et al., 2021 [152] Raman et al., 2021 [63] Szekely et al., 2021 [153] Rinaldo et al., 2021 [154] Kersten et al., 2021 [155] Mohr et al., 2021 [156] |
6 5 6 5 5 5 |
| Severe | 2–4 mo | In patients recovering from COVID-19 pneumonia, physical deconditioning is the most common cause of impaired peak oxygen consumption (19/35 (54%) of sample had peak oxygen consumption <80% of predicted). | Jahn et al., 2021 [157] | 5 | |
| All degrees | 6 mo | Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate and peak oxygen consumption. Compared with asymptomatic recoverees, those with persistent dyspnoea had lower peak oxygen consumption (88% (76%–100%) of predicted). | Ladlow et al., 2021 [158] Aparisi et al., 2021 [159] |
5 6 |
|
| All degrees | 9 mo | Physiological abnormalities on CPET were mild (peak oxygen consumption was 86% (69%–100%) of predicted) and similar to matched historical controls with dyspnoea without antecedent COVID-19. Most (59%) had peak oxygen consumption <80% predicted (mean: 77% ± 21%) and circulatory limitation to exercise. Most of those with normal peak oxygen consumption had ventilatory abnormalities. |
Alba et al., 2021 [160] Mancini et al., 2021 [161] |
6 5 |
|
| Brain imaging | |||||
| PET CT | Any severity | 3 mo | Increased number of functional complaints was correlated with hypometabolism of the brainstem and cerebellum cluster | Guedj et al., 2021 [79] | 5 |
| Brain MRI | Moderate to severe | 2–3 mo | Higher rates vs. control group of higher T2 signal on susceptibility-weighted imaging in left and right thalamus; increased mean diffusivity in left posterior thalamic radiation and left and right averaged sagittal stratum. Compared with controls, volumetric and microstructural abnormalities were detected mainly in central olfactory cortices, partial white matter in right hemisphere | Raman et al., 2021 [63] Lu et al., 2020 [162] |
6 7 |
6MWT, 6-minute walk test; AMSTAR, A MeaSurement Tool to Assess systematic Reviews; EF, ejection fraction; SPO2, peripheral capillary oxygen saturation; SPPB, short physical performance battery; STS; sit to stand.