Arq. Bras. Cardiol. 2023; 120(5): e20220642

Post-COVID-19 Cardiopulmonary Symptoms: Predictors and Imaging Features in Patients after Hospital Discharge

Kalil-Filho Roberto, Roberta Saretta, André Franci, Luciano M. Baracioli, Filomena R. B. G. Galas, Juliana S. Gil, Amanda Ferino, Camilla Giacovone, Isabella Oliveira, Johnatan Souza, Vanessa Batista, Augusto Scalabrini Neto, Livia do Valle Costa, Amanda Danieleto Ruiz, Carla B. Ledo, Teresa Cristina D. C. Nascimento , Luciano F. Drager

DOI: 10.36660/abc.20220642

This Original Article is referred by the Short Editorial "The Clinical Impact of Cardiovascular Symptoms on Post-Acute COVID-19 Syndrome".

Abstract

Background

Most of the evidence about the impact of the post-acute COVID-19 Syndrome (PACS) reports individual symptoms without correlations with related imaging.

Objectives

To evaluate cardiopulmonary symptoms, their predictors and related images in COVID-19 patients discharged from hospital.

Methods

Consecutive patients who survived COVID-19 were contacted 90 days after discharge. The Clinic Outcome Team structured a questionnaire evaluating symptoms and clinical status (blinded for hospitalization data). A multivariate analysis was performed to address the course of COVID-19, comorbidities, anxiety, depression, and post-traumatic stress during hospitalization, and cardiac rehabilitation after discharge. The significance level was set at 5%.

Results

A total of 480 discharged patients with COVID-19 (age: 59±14 years, 67.5% males) were included; 22.3% required mechanical ventilation. The prevalence of patients with PACS-related cardiopulmonary symptoms (dyspnea, tiredness/fatigue, cough, and chest discomfort) was 16.3%. Several parameters of chest computed tomography and echocardiogram were similar in patients with and without cardiopulmonary symptoms. The multivariate analysis showed that PACS-related cardiopulmonary-symptoms were independently related to female sex (OR 3.023; 95% CI 1.319-6.929), in-hospital deep venous thrombosis (OR 13.689; 95% CI 1.069-175.304), elevated troponin I (OR 1.355; 95% CI 1.048-1.751) and C-reactive protein during hospitalization (OR 1.060; 95% CI 1.023-1.097) and depression (OR 6.110; 95% CI 2.254-16.558).

Conclusion

PACS-related cardiopulmonary symptoms 90 days post-discharge are common and multifactorial. Beyond thrombotic and markers of inflammation/myocardial injury during hospitalization, female sex and depression were independently associated with cardiopulmonary-related PACS. These results highlighted the need for a multifaceted approach targeting susceptible patients.