Evaluation of pulmonary and endothelial function, autonomic cardiac control and its relation to the exercise capacity in surviving patients of COVID-19: a segment study

Abstract

The World Health Organization (WHO) has declared the disease caused by the Coronavirus 2019 (COVID-19) a public health emergency, since a portion of these patients is suffering from acute respiratory syndrome and the need for mechanical ventilation, with morbidity and mortality outcomes. For COVID-19 survivors, functional disability appears to be disproportionate to the degree of impaired lung function and may be due to additional factors, such as physical deconditioning, steroid-related musculoskeletal complications, neuropathy/myopathy related to comorbidities. However, there are no studies on cardiovascular and pulmonary complications in survivors of COVID-19 as well as its impact on functional capacity.Aim: Assess the impact of COVID-19 on maximum physical capacity and the relationship with the incidence of decompensation and death in a 1-year follow-up. Study Design: Prospective and 1-year segment study. All patients who were diagnosed with COVID-19 screened at the UFSCar University Hospital and Santa Casa de São Carlos after hospital discharge and who have completed quarantine will be invited to participate.Methods: All patients will undergo the following steps: (I) clinical and pulmonary function assessment measured by whole body plethysmography (lung volumes by means of static and dynamic inspiratory maneuvers, pulmonary diffusion capacity, respiratory muscle strength and drive (P.0.1); (II) heart rate variability; (III) brachial artery flow-mediated vasodilation using ultrasound images; (IV) cardiopulmonary exercise test on a cycle ergometer. After one year of evaluation, all patients will be reassessed for clinical condition, pulmonary and endothelial function and exercise capacity, outcomes such as difference in O2 between groups, hospitalizations and death will be assessed after one year.Hypothesis: We believe that survivors of COVID-19 will have impaired pulmonary and endothelial function, reduced exercise capacity, and a higher incidence of comorbidities, hospitalizations and death in the 1-year follow-up, when compared to patients with a negative diagnosis for COVID-19. (AU)