key: cord-0740034-2mn9cf79
authors: CANO CARRIZAL, Rubén; CASANOVA RODRÍGUEZ, Carlos
title: Surgical facemask: an ally of exercise stress echocardiography during the COVID-19 pandemic?
date: 2020-10-29
journal: Rev Esp Cardiol (Engl Ed)
DOI: 10.1016/j.rec.2020.10.007
sha: 9e2daf8a9b6bee8bff9b660229001b8cf9bb312f
doc_id: 740034
cord_uid: 2mn9cf79

nan

To the Editor,

The American Society of Echocardiography (ASE) has recently published a document with recommendations for the reintroduction of activity in echocardiography laboratories during the coronavirus disease 2019 (COVID-19) pandemic. 1 Regarding stress echocardiography, a key diagnostic tool in patients with coronary heart disease or suspected coronary heart disease, many studies have been delayed, giving priority to the pharmacological modality over the exercise modality, following previous ASE recommendations. 2 Nonetheless, exercise stress echocardiography (ESE) provides us with very valuable information such as the patient's functional capacity and chronotropic response. The use of a surgical mask during ESE is currently recommended, since it has been shown to reduce the transmission of respiratory viruses. 3 On the other hand, its use during exercise has demonstrated a negative impact on cardiopulmonary capacity, as well as increasing the feeling of discomfort, in healthy volunteers. 4 This could lead us to inconclusive studies in our patients. The aim of our study was to assess whether the use of a surgical facemask during ESE negatively impacts on patients' functional capacity and the percentage of conclusive studies.

We conducted a retrospective analysis including those patients who came to our center to perform an ESE from the resumption of our activity on 10/04/2020 to 30/07/2020. Studies in patients with active or highly suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were cancelled. We selected those patients in sinus rhythm whose indication was diagnosis or prognostic assessment of coronary heart disease. A symptom-limited standard Bruce protocol was performed. A surgical facemask was placed on all patients to carry out the test, completely covering the nose and mouth, and was not allowed to be removed at any moment. As a control group, we used patients who attended our center to perform an ESE with equal inclusion Previous studies have shown that heart rate during exercise is increased by the use of surgical facemasks in healthy participants. 5 This may partly explain the higher percentage of conclusive studies obtained. The main weakness of our study is the impossibility of using the same patients without a facemask as their own control group, given the risk of aerosolization during ESE in the current pandemic situation. Given the retrospective nature of the analysis, it has not been possible to incorporate other variables related to chronotropic response, such as the level of sedentariness.

However, this bias was mitigated by the use of body mass index as a surrogate variable. Finally, we cannot exclude a possible causal role of physical deconditioning, caused by confinement, on the maximum heart rate achieved.

In conclusion, our study demonstrates that ESE with a surgical facemask is a feasible procedure. 

ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic

ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak: Endorsed by the American College of Cardiology

Respiratory virus shedding in exhaled breath and efficacy of facemasks

Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity

Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations