Cardiovascular evaluation using exercise testing performed with face masks during the COVID-19 pandemic

Hermes Ilazarra-Lomelí , Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Jessica Rojano-Castillo, Miembro Titular de la Sociedad Mexicana de Cardiología; Especialista en Cardiología Clínica, Rehabilitación Cardiaca y Prevención Secundaria;; Miembro Titular de la Sociedad Mexicana para el Cuidado del Corazón; Especialista en Cardiología Clínica y Ecocardiografía; Ciudad de México, México
Gonzalo Carazo, Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Saray Flores, Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Carlos Barrera-Ramírez, Department of Cardiology, Hospital Universitario de Saltillo, Saltillo, Coahuila, Mexico
María D. Rius-Suárez, Servicio de Rehabilitación Cardiaca del Centro Médico nacional “20 de Noviembre”, Ciudad de México, México
Hannah Ortega-Aranda, Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

Objective: COVID-19 pandemic is associated with high incidence and fatality, however, non-communicable diseases remain a global public health problem with even greater morbidity and mortality. At present, there is a lag in diagnosis and treatment of patients with heart disease, particularly the performance of exercise testing (ET), due to the fear of aerosol generation and viral dissemination. Although some centers carry out the tests with the use of masks, the information is still superficial and preliminary. The objective of the study was to describe the ergometric performance observed when performing exercise tests during the COVID-19 (PANDEMIC-G) pandemic and to highlight the differences with those results carried out in another time, when there was no COVID-19 (NO PANDEMIC). Method: A cross-sectional study was carried out. PANDEMIC-G patients underwent ET between March 2020 and December 2020, once a biological triage was done and all of them wore N95 masks. They were compared to NO PANDEMIC patients that performed an ET between March 2019 and December 2019. Demographic and ergometric variables were presented and analyzed according to their type. All p < 0.05 were considered stochastically significant. Results: A total of 361 ET were studied: 209 (58%) belonged to NO PANDEMIC and 152 (42%) to PANDEMIC-G. The number of ET stopped by dyspnea was greater in PANDEMIC-G (117) than in NO PANDEMIC (8). Exercise tolerance did not show significant changes. Systolic blood pressure, double product, and myocardial oxygen utilization were higher in PANDEMIC-G ET (p < 0.01). Conclusions: In the COVID-era, fewer stress tests were performed, which were suspended more frequently due to dyspnea. Higher values of systolic blood pressure and myocardial oxygen utilization were observed in PANDEMIC-G as well.

Keywords: COVID. Exercise testing. Blood pressure. Mask. Exercise tolerance. Diagnostic test.