2023
Differential cardiopulmonary haemodynamic phenotypes in PASC-related exercise intolerance
Kahn P, Joseph P, Heerdt P, Singh I. Differential cardiopulmonary haemodynamic phenotypes in PASC-related exercise intolerance. ERJ Open Research 2023, 10: 00714-2023. PMID: 38348243, PMCID: PMC10860209, DOI: 10.1183/23120541.00714-2023.Peer-Reviewed Original ResearchInvasive cardiopulmonary exercise testingRight heart catheterizationPASC patientsExertional intoleranceCardiac outputPulmonary artery wedge pressurePeak VO 2Supranormal cardiac outputPeak exercise capacityCardiopulmonary exercise testingMaximal voluntary ventilationPost-acute sequelaeBody mass indexSystemic oxygen extractionMild acute illnessSARS-CoV-2Exercise hemodynamicsHFpEF patientsHFpEF phenotypeHeart catheterizationWedge pressureAcute illnessExercise capacityExercise testingHemodynamic abnormalitiesProteomic profiling demonstrates inflammatory and endotheliopathy signatures associated with impaired cardiopulmonary exercise hemodynamic profile in Post Acute Sequelae of SARS‐CoV‐2 infection (PASC) syndrome
Singh I, Leitner B, Wang Y, Zhang H, Joseph P, Lutchmansingh D, Gulati M, Possick J, Damsky W, Hwa J, Heerdt P, Chun H. Proteomic profiling demonstrates inflammatory and endotheliopathy signatures associated with impaired cardiopulmonary exercise hemodynamic profile in Post Acute Sequelae of SARS‐CoV‐2 infection (PASC) syndrome. Pulmonary Circulation 2023, 13: e12220. PMID: 37091121, PMCID: PMC10113513, DOI: 10.1002/pul2.12220.Peer-Reviewed Original ResearchInvasive cardiopulmonary exercise testPASC patientsPost-acute sequelaeAcute sequelaeInfection syndromeUnexplained exertional intoleranceCardiopulmonary exercise testSystemic oxygen deliveryPersistent inflammatory stateVenous blood plasmaExertional intolerancePeak exerciseEndothelial dysfunctionHemodynamic profileInflammatory stateExercise testFibrotic processPathophysiological hallmarkAberrant protein expressionExpression of proteinsOxygen deliveryOxygen extractionProteomic profilingPatientsPhysiologic responsesExercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2 More in Common Than Not?
Joseph P, Singh I, Oliveira R, Capone C, Mullen M, Cook D, Stovall M, Squires J, Madsen K, Waxman A, Systrom D. Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2 More in Common Than Not? CHEST Journal 2023, 164: 717-726. PMID: 37054777, PMCID: PMC10088277, DOI: 10.1016/j.chest.2023.03.049.Peer-Reviewed Original ResearchConceptsMyalgic encephalomyelitis/chronic fatigue syndromeME/CFSChronic fatigue syndromeSARS-CoV-2Fatigue syndromePostacute sequelaeCardiopulmonary exercise testingSystemic blood flowExercise pathophysiologyExertional intoleranceIntractable fatigueExercise testingAcute infectionPostexertional malaiseExercise intoleranceOrthostatic intoleranceVentilatory controlLong-term consequencesBlood flowClinical overlapSuch symptomsIntoleranceSequelaeCOVID-19Syndrome
2022
Acute Effect of Pyridostigmine in Exertional Intolerance in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Randomized Placebo-Controlled Clinical Trial
Stovall M, Joseph P, Pari R, Warren A, Miller S, Squires J, Xiao W, Waxman A, Systrom D. Acute Effect of Pyridostigmine in Exertional Intolerance in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Randomized Placebo-Controlled Clinical Trial. 2022, a2063-a2063. DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a2063.Peer-Reviewed Original Research
2021
Persistent Exertional Intolerance After COVID-19 Insights From Invasive Cardiopulmonary Exercise Testing
Singh I, Joseph P, Heerdt PM, Cullinan M, Lutchmansingh DD, Gulati M, Possick JD, Systrom DM, Waxman AB. Persistent Exertional Intolerance After COVID-19 Insights From Invasive Cardiopulmonary Exercise Testing. CHEST Journal 2021, 161: 54-63. PMID: 34389297, PMCID: PMC8354807, DOI: 10.1016/j.chest.2021.08.010.Peer-Reviewed Original ResearchConceptsInvasive cardiopulmonary exercise testingCardiopulmonary exercise testingCardiopulmonary diseaseExercise testingControl participantsPeak VOExertional limitationCOVID-19Greater ventilatory inefficiencyPeak cardiac indexSex-matched control participantsCohort of patientsSystemic oxygen extractionDead space ventilationOnly mild symptomsExertional intoleranceCardiac indexPulmonary hemodynamicsAcute infectionVentilatory inefficiencyExercise intolerancePathophysiologic mechanismsMild symptomsHyperventilatory responseOxygen extractionInsights From Invasive Cardiopulmonary Exercise Testing of Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Joseph P, Arevalo C, Oliveira RKF, Faria-Urbina M, Felsenstein D, Oaklander AL, Systrom DM. Insights From Invasive Cardiopulmonary Exercise Testing of Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. CHEST Journal 2021, 160: 642-651. PMID: 33577778, PMCID: PMC8727854, DOI: 10.1016/j.chest.2021.01.082.Peer-Reviewed Original ResearchConceptsSmall fiber neuropathyRight atrial pressurePostural orthostatic tachycardiaMyalgic encephalomyelitis/chronic fatigue syndromeCardiopulmonary exercise testingChronic fatigue syndromeExertional intoleranceExercise testingFatigue syndromeControl subjectsOxygen extractionInvasive cardiopulmonary exercise testingLow right atrial pressureME/CFS criteriaHigh pulmonary blood flowME/CFS patientsPeripheral oxygen extractionSmall fiber pathologyPulmonary blood flowSystemic oxygen extractionCardiac returnIntrinsic heartNeurovascular dysregulationRight shuntingCFS patients