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The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Patients with a history of acute COVID-19 showed elevated inflammatory markers associated with reduced exercise capacity more than a year later in a prospective cohort study.

  • Cardiopulmonary symptoms and reduced exercise capacity in such cases are associated with impaired chronotropic response to exercise.

Why This Matters

  • Cardiopulmonary testing should be performed to assess heart rate response to exercise and identify etiologies of persistent symptoms in patients with postacute sequelae of COVID-19 (PASC), also known as long COVID.

  • Anti-inflammatory therapy and exercise strategies in patients with PASC should include symptom assessment and cardiopulmonary exercise testing.

Study Design

  • The study involved 120 participants (median age, 52 years; 39% female) with 1-year or longer history of PCR-confirmed SARS-CoV-2 infection who did not have a history of significant cardiopulmonary disease who were participants in the Long-Term Impact of Infection with Novel Coronavirus (LIINC) longitudinal cohort study.

  • Participants were given the opportunity to undergo cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR), and/or ambulatory rhythm monitoring, regardless of their symptom status, to assess any cardiopulmonary PASC.

Key Results

  • Of the 120 participants, 46 underwent at least one of the advanced cardiac tests a median of 17 months after their acute COVID-19 episode.

  • Of those 46 participants, synthroid medication weight loss 25 showed symptoms and 21 did not.

  • Exercise capacity was reduced in significantly more participants with either cardiopulmonary symptoms or fatigue than in those without symptoms (57% vs 12%; P = .008).

  • Peak VO2 averaged 5.9 mL/kg per min lower for participants with symptoms than without (P = .002) and was 21% lower than predicted (P = .006) in adjusted analysis.

  • Chronotropic incompetence was identified in 60% (9/15) of those with reduced peak VO2.

  • An adjusted heart rate reserve less than 80% was associated with reduced exercise capacity (odds ratio [OR], 15.6; 95% CI, 1.30 – 187; P = .03).

  • Inflammatory markers and SARS-CoV-2 antibody levels measured early in PASC were negatively correlated with peak VO2 more than 1 year later.

  • No such associations with peak VO2 were observed for troponins or natriuretic peptide levels.


  • The observation study is subject to selection bias.

  • Volunteer bias may have overestimated the prevalence of reduced exercise capacity.

  • The study did not include a control group without a history of SARS-CoV-2 infection.


  • This study was funded by philanthropic gifts from Charles W. Swanson and the Ed and Pearl Fein Foundation, research grants from the National Institutes of Health, and internal funds from the Division of Cardiology at Zuckerberg San Francisco General Hospital.

  • Four coauthors are employees of Monogram Biosciences, a division of LabCorp.

  • The senior author has received modest honoraria from Gilead and Merck and a research grant from Novartis unrelated to the submitted work.

This is a summary of a preprint research study, Inflammation during early post-acute COVID-19 is associated with reduced exercise capacity and Long COVID symptoms after 1 year, written by Matthew S. Durstenfeld, MD, from the University of California, San Francisco, and colleagues on provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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