The effect of COVID-19 on cardiovascular function and exercise tolerance in healthy middle-age and older individuals

Abstract

Aims: Coronavirus disease (COVID-19) can affect cardiovascular function in health and disease. The present study assessed the effect of prior COVID-19 infection on cardiovascular phenotype at rest and in response to exercise in middle age and older individuals. Methods: This case-control, single-centre study recruited 124 participants: 84 with a history of COVID-19 (59.9 ± 7.41 years, 54.8% female) and 40 participants without history of COVID-19 infection (62.8 ± 7.14 years, 62.5% female). All participants underwent non-invasive assessment of arterial function using pulse wave velocity (PWV), augmentation index (Alx) and hemodynamic function (i.e. cardiac index (CI), stroke volume index (SVI), heart rate (HR), mean arterial blood pressure (MAP)) at rest. Cardiopulmonary exercise stress testing with simultaneous gas exchange and hemodynamic (bioreactance) measurements was also performed. Results: There were no differences between COVID-19 and non-COVID-19 groups in PWV (COVID-19: 7.52 ± 1.66 m/s, non-COVID-19: 7.32 ± 1.79 m/s, p = 0.440); Alx (COVID-19: 29.2 ± 9.12%, non-COVID-19: 29.2 ± 8.44%, p = 0.980); CI (COVID-19: 2.85 ± 0.39 L/min/m2, non-COVID-19: 2.79 ± 0.37 L/min/m2, p = 0.407); SVI (COVID-19: 46.5 ± 7.54 mL/m2, non-COVID-19: 47.0 ± 7.59 mL/m2, p = 0.776), HR (COVID-19: 62.3 ± 10.6 beats/min, Non-COVID-19: 60.2 ± 8.52 beats/min, p = 0.263), or MAP (COVID-19: 98.1 ± 11.2 mmHg, non-COVID-19: 96.6 ± 9.46 mmHg, p = 0.464). COVID-19 participants however demonstrated lower O2 consumption at anaerobic threshold (15.5 ± 4.25 vs 16.8 ± 4.51 mL/kg/m2, p = 0.034), peak cardiac index (10.4 ± 2.3 vs 11.3 ± 2.5 L/min/m2, p = 0.040) and peak stroke volume index (82.1 ± 25.3 vs 98.6 ± 37.6 mL/m2, p = 0.028). Conclusion: Healthy middle-age and older individuals with history COVID-19 infection demonstrate reduced exercise tolerance and cardiac function response to exercise.