Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome

Patients recovering from COVID-19 commonly report persistence of dyspnea, exertional fatigue, and difficulties in carrying out their daily activities. However, the nature of these symptoms is still unknown. The purpose of the study was to identify limiting causes of cardiopulmonary origin for the performance of physical exercise in post-COVID-19 condition that could explain the symptomatic persistence of dyspnea or fatigue-related symptoms. Thirty-two non-hospitalized patients with post-COVID-19 condition (i.e., still presenting a chronic symptomatic phase lasting >90 days since debut of symptoms that lasted for at least 2 months and cannot be explained by an alternative diagnosis) completed a clinical examination including echocardiography, submaximal and maximal cardiorespiratory fitness tests (Ekblom-Bak and Bruce’s protocols), and a battery of validated questionnaires about fatigue and exercise intolerance. Four participants (12.5%) reported an abnormal cardiac response to exercise during the submaximal test, which aroused suspicion of the presence of chronotropic incompetence. All of them were confirmed with a positive diagnosis maximal exercise test after cardiology screening, even with a comprehensive clinical examination, resting ECG, and echocardiogram, without other findings. No statistical differences were found in any physiological variables or questionnaire values, between patients with positive and negative diagnoses. Chronotropic incompetence and other autonomic disorders may appear in patients with mild forms of COVID-19 presentation and may persist in the long term, being responsible for exercise intolerance after resolution of acute infection. Clinicians should be aware that chronotropic incompetence and other autonomic disorders may be a complication of COVID-19 and should consider appropriate diagnostic and therapeutic interventions in these patients, especially when early exercise-related fatigability is reported.

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Chronotropic incompetence is more frequent in obese adolescents and relates to systemic inflammation and exercise intolerance

Journal of Sport and Health Science ◽

10.1016/j.jshs.2021.01.010 ◽

2021 ◽

Author(s):

Wouter M.A. Franssen ◽

Charly Keytsman ◽

Nastasia Marinus ◽

Kenneth Verboven ◽

Bert O. Eijnde ◽

...

Keyword(s):

Systemic Inflammation ◽

Exercise Intolerance ◽

Chronotropic Incompetence ◽

Obese Adolescents

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Metabolic and hemodynamic responses of lower limb during exercise in patients with COPD

Journal of Applied Physiology ◽

10.1152/jappl.1998.84.5.1573 ◽

1998 ◽

Vol 84 (5) ◽

pp. 1573-1580 ◽

Cited By ~ 100

Author(s):

François Maltais ◽

Jean Jobin ◽

Martin J. Sullivan ◽

Sarah Bernard ◽

François Whittom ◽

...

Keyword(s):

Blood Flow ◽

Lactic Acidosis ◽

Blood Lactate ◽

Lower Limb ◽

Submaximal Exercise ◽

Exercise Intolerance ◽

Early Exercise ◽

Lactate Release ◽

Leg Blood Flow ◽

Copd Patients

Premature lactic acidosis during exercise in patients with chronic obstructive pulmonary disease (COPD) may play a role in exercise intolerance. In this study, we evaluated whether the early exercise-induced lactic acidosis in these individuals can be explained by changes in peripheral O2 delivery (D˙o 2). Measurements of leg blood flow by thermodilution and of arterial and femoral venous blood gases, pH, and lactate were obtained during a standard incremental exercise test to capacity in eight patients with severe COPD and in eight age-matched controls. No significant difference was found between the two groups in leg blood flow at rest or during exercise at the same power outputs. Blood lactate concentrations and lactate release from the lower limb were greater in COPD patients at all submaximal exercise levels (all P < 0.05). LegD˙o 2at a given power output was not significantly different between the two groups, and no significant correlation was found between this parameter and blood lactate concentrations. COPD patients had lower arterial and venous pH at submaximal exercise, and there was a significant positive correlation between venous pH at 40 W and the peak O2 uptake ( r = 0.91, P < 0.0001). The correlation between venous pH and peak O2 uptake suggests that early muscle acidosis may be involved in early exercise termination in COPD patients. The early lactate release from the lower limb during exercise could not be accounted for by changes in peripheralD˙o 2. The present results point to skeletal muscle dysfunction as being responsible for the early onset of lactic acidosis in COPD.

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Chronotropic Incompetence and its Relation to Exercise Intolerance in Chronic Obstructive Pulmonary Disease

The American Journal of the Medical Sciences ◽

10.1016/j.amjms.2016.12.015 ◽

2017 ◽

Vol 353 (3) ◽

pp. 216-223 ◽

Cited By ~ 2

Author(s):

Hai-jian Liu ◽

Jian Guo ◽

Qin-hua Zhao ◽

Lan Wang ◽

Wen-lan Yang ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Exercise Intolerance ◽

Chronic Obstructive ◽

Chronotropic Incompetence ◽

Obstructive Pulmonary Disease

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Emotional Transfer in Human–Horse Interaction: New Perspectives on Equine Assisted Interventions

Animals ◽

10.3390/ani9121030 ◽

2019 ◽

Vol 9 (12) ◽

pp. 1030

Author(s):

Chiara Scopa ◽

Laura Contalbrigo ◽

Alberto Greco ◽

Antonio Lanatà ◽

Enzo Pasquale Scilingo ◽

...

Keyword(s):

Therapeutic Interventions ◽

Emotional States ◽

Emotional Involvement ◽

Communicative Skills ◽

Positive Effects ◽

Physiological Variables ◽

Coupling System ◽

Proximate Causation ◽

Equine Assisted ◽

Fine Tune

Equine assisted interventions (EAIs) include all therapeutic interventions aimed at improving human wellbeing through the involvement of horses. Due to the prominent emotional involvement traditionally characterizing their relation with humans, horses developed sophisticated communicative skills, which fostered their ability to respond to human emotional states. In this review, we hypothesize that the proximate causation of successful interventions could be human–animal mutual coordination, through which the subjects bodily and, most importantly, emotionally come into contact. We propose that detecting emotions of other individuals and developing the capacity to fine-tune one’s own emotional states accordingly (emotional transfer mechanism), could represent the key engine triggering the positive effects of EAIs. We provide a comprehensive analysis of horses’ socio-emotional competences according to recent literature and we propose a multidisciplinary approach to investigate this inter-specific match. By considering human and horse as a unique coupling system during the interaction, it would be possible to objectively measure the degree of coordination through the analysis of physiological variables of both human and animal. Merging the state of art on human–horse relationship with the application of novel methodologies, could help to improve standardized protocols for animal assisted interventions, with particular regard to the emotional states of subjects involved.

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Proliferation of primary human hepatocytes and prevention of hepatitis B virus reinfection efficiently deplete nuclear cccDNA in vivo

Gut ◽

10.1136/gutjnl-2016-312162 ◽

2017 ◽

Vol 67 (3) ◽

pp. 542-552 ◽

Cited By ~ 58

Author(s):

Lena Allweiss ◽

Tassilo Volz ◽

Katja Giersch ◽

Janine Kah ◽

Giuseppina Raffa ◽

...

Keyword(s):

Acute Infection ◽

In Situ Hybridisation ◽

Human Hepatocytes ◽

Human Hepatocyte ◽

Therapeutic Interventions ◽

Viral Spread ◽

Primary Human Hepatocytes ◽

The Stability ◽

The Impact

ObjectiveThe stability of the covalently closed circular DNA (cccDNA) in nuclei of non-dividing hepatocytes represents a key determinant of HBV persistence. Contrarily, studies with animal hepadnaviruses indicated that hepatocyte turnover can reduce cccDNA loads but knowledge on the proliferative capacity of HBV-infected primary human hepatocytes (PHHs) in vivo and the fate of cccDNA in dividing PHHs is still lacking. This study aimed to determine the impact of human hepatocyte division on cccDNA stability in vivo.MethodsPHH proliferation was triggered by serially transplanting hepatocytes from HBV-infected humanised mice into naïve recipients. Cell proliferation and virological changes were assessed by quantitative PCR, immunofluorescence and RNA in situ hybridisation. Viral integrations were analysed by gel separation and deep sequencing.ResultsPHH proliferation strongly reduced all infection markers, including cccDNA (median 2.4 log/PHH). Remarkably, cell division appeared to cause cccDNA dilution among daughter cells and intrahepatic cccDNA loss. Nevertheless, HBV survived in sporadic non-proliferating human hepatocytes, so that virological markers rebounded as hepatocyte expansion relented. This was due to reinfection of quiescent PHHs since treatment with the entry inhibitor myrcludex-B or nucleoside analogues blocked viral spread and intrahepatic cccDNA accumulation. Viral integrations were detected both in donors and recipient mice but did not appear to contribute to antigen production.ConclusionsWe demonstrate that human hepatocyte division even without involvement of cytolytic mechanisms triggers substantial cccDNA loss. This process may be fundamental to resolve self-limiting acute infection and should be considered in future therapeutic interventions along with entry inhibition strategies.

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Responsiveness of Various Exercise-Testing Protocols to Therapeutic Interventions in COPD

Pulmonary Medicine ◽

10.1155/2013/410748 ◽

2013 ◽

Vol 2013 ◽

pp. 1-11 ◽

Cited By ~ 32

Author(s):

Benoit Borel ◽

Steeve Provencher ◽

Didier Saey ◽

François Maltais

Keyword(s):

Exercise Testing ◽

Exercise Tolerance ◽

Work Rate ◽

Therapeutic Interventions ◽

Exercise Intolerance ◽

Chronic Obstructive ◽

Exercise Tests ◽

Obstructive Pulmonary Disease ◽

Constant Work Rate ◽

Testing Protocols

Exercise intolerance is a key element in the pathophysiology and course of Chronic Obstructive Pulmonary Disease (COPD). As such, evaluating exercise tolerance has become an important part of the management of COPD. A wide variety of exercise-testing protocols is currently available, each protocol having its own strengths and weaknesses relative to their discriminative, methodological, and evaluative characteristics. This paper aims to review the responsiveness of several exercise-testing protocols used to evaluate the efficacy of pharmacological and nonpharmacological interventions to improve exercise tolerance in COPD. This will be done taking into account the minimally important difference, an important concept in the interpretation of the findings about responsiveness of exercise testing protocols. Among the currently available exercise-testing protocols (incremental, constant work rate, or self-paced), constant work rate exercise tests (cycle endurance test and endurance shuttle walking test) emerge as the most responsive ones for detecting and quantifying changes in exercise capacity after an intervention in COPD.

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A Longitudinal SARS-CoV-2 Biorepository for COVID-19 Survivors with and without Post-Acute Sequelae

10.21203/rs.3.rs-493160/v1 ◽

2021 ◽

Author(s):

Stephanie M LaVergne ◽

Stromberg Sophia ◽

Bridget A Baxter ◽

Tracy L Webb ◽

Taru S Dutt ◽

...

Keyword(s):

Demographic Data ◽

Acute Infection ◽

Exercise Intolerance ◽

Future Research ◽

Clinical Trial Registration ◽

Targeted Interventions ◽

Persistent Symptoms ◽

Northern Colorado ◽

History Of

Abstract BackgroundSARS-CoV-2 has swept across the globe, causing millions of deaths worldwide. Though most survive, many experience symptoms of COVID-19 for months after acute infection. Successful prevention and treatment of acute COVID-19 infection and its associated sequelae is dependent on in-depth knowledge of viral pathology across the spectrum of patient phenotypes and physiologic responses. Longitudinal biobanking provides a valuable resource of clinically integrated, easily accessed, and quality-controlled samples for researchers to study differential multi-organ system responses to SARS-CoV-2 infection, post-acute sequelae of COVID-19 (PASC), and vaccination. MethodsAdults with a history of a positive SARS-CoV-2 nasopharyngeal PCR are actively recruited from the community or hospital settings to enroll in the Northern Colorado SARS-CoV-2 Biorepository (NoCo-COBIO). Blood, saliva, stool, nasopharyngeal specimens, and extensive clinical and demographic data are collected at 4 time points over 6 months. Patients are assessed for PASC during longitudinal follow-up by physician led symptom questionnaires and physical exams. This clinical trial registration is NCT05603677.ResultsWe have enrolled and collected samples from 119 adults since July 2020, with 66% follow-up rate. Forty-nine percent of participants assessed with a symptom surveillance questionnaire (N=37 of 75) had PASC at any time during follow-up (up to 8 months post infection). Ninety-three percent of hospitalized participants developed PASC, while 23% of those not requiring hospitalization developed PASC. At 90-174 days post SARS-CoV-2 diagnosis, 67% of all participants had persistent symptoms (N=37 of 55), and 85% percent of participants who required hospitalization during initial infection (N=20) still had symptoms. The most common symptoms reported after 15 days of infection were fatigue, loss of smell, loss of taste, exercise intolerance, and cognitive dysfunction. ConclusionsPatients who were hospitalized for COVID-19 were significantly more likely to have PASC than those not requiring hospitalization, however 23% of patients who were not hospitalized also developed PASC. This patient-matched, multi-matrix, longitudinal biorepository from COVID-19 survivors with and without PASC will allow for current and future research to better understand the pathophysiology of disease and to identify targeted interventions to reduce risk for PASC. Registered 27 October 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04603677.

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Neurological assessment of the acute cardiac care patient

10.1093/med/9780199687039.003.0016_update_001 ◽

2018 ◽

Author(s):

Cathy De Deyne ◽

Ward Eertmans ◽

Jo Dens

Keyword(s):

Clinical Examination ◽

Cerebral Perfusion ◽

Cerebral Oxygenation ◽

Blood Pressure Monitoring ◽

Gas Analysis ◽

Cardiac Care ◽

Arterial Blood Gas ◽

Physiological Variables ◽

Arterial Blood ◽

Cerebral Monitoring

Many techniques are currently available for cerebral physiological monitoring in the intensive cardiac care unit environment. The ultimate goal of cerebral monitoring applied during the acute care of any patient with/or at risk of a neurological insult is the early detection of regional or global hypoxic/ischaemic cerebral insults. In the most ideal situation, cerebral monitoring should enable the detection of any deterioration before irreversible brain damage occurs or should at least enable the preservation of current brain function (such as in comatose patients after cardiac arrest). Most of the information that affects bedside care of patients with acute neurologic disturbances is now derived from clinical examination and from knowledge of the pathophysiological changes in cerebral perfusion, cerebral oxygenation, and cerebral function. Online monitoring of these changes can be realized by many non-invasive techniques, without neglecting clinical examination and basic physiological variables—with possible impact on optimal cerebral perfusion/oxygenation—such as invasive arterial blood pressure monitoring or arterial blood gas analysis.

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