RT Journal Article SR Electronic T1 Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19 JF BMJ Military Health JO BMJ Mil Health FD British Medical Journal Publishing Group SP e002193 DO 10.1136/military-2022-002193 A1 D A Holdsworth A1 R M Barker-Davies A1 R R Chamley A1 O O’Sullivan A1 P Ladlow A1 S May A1 A D Houston A1 J Mulae A1 C Xie A1 M Cranley A1 E Sellon A1 J Naylor A1 M Halle A1 G Parati A1 C Davos A1 O J Rider A1 A B Bennett A1 E D Nicol YR 2022 UL http://militaryhealth.bmj.com/content/early/2022/11/27/military-2022-002193.abstract AB Objective Post-COVID-19 syndrome presents a health and economic challenge affecting ~10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings.Methods 113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease.Results 7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O2 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V̇O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO2) slope <30.0 or VE/V̇CO2 slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar–arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease.Conclusions In a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.Data are available on reasonable request. Data may be obtained on approach to the corresponding author, subject to any limitations required on the basis of the group representing a Defence population.