Mancini, Donna M, Brunjes, Danielle L, Lala, Anuradha et al. · JACC. Heart failure · 2021 · DOI
This study looked at 41 people who had long-lasting breathing problems after COVID-19, even though their standard lung and heart tests appeared normal. Researchers used a special exercise test to measure how well their bodies could use oxygen and how they breathed during activity. They found that most patients had unusual breathing patterns or reduced exercise capacity, and about half met the criteria for ME/CFS.
This work demonstrates that objective physiological abnormalities—circulatory impairment and dysfunctional breathing—underlie unexplained dyspnea in PASC and ME/CFS, validating patient symptoms and providing measurable diagnostic tools. It bridges post-COVID syndrome and ME/CFS, suggesting shared pathophysiological mechanisms in both populations.
This study does not establish causation—whether dysfunctional breathing causes ME/CFS or vice versa. It cannot determine the prevalence of these findings in the general population, as it lacks a control group. The cross-sectional design cannot track whether these abnormalities persist, improve, or worsen over time.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Mancini, Donna M, Brunjes, Danielle L, Lala, Anuradha, Trivieri, Maria Giovanna, Contreras, Johanna P, & Natelson, Benjamin H (2021). Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post-Coronavirus Disease.. JACC. Heart failure. https://doi.org/10.1016/j.jchf.2021.10.002
BibTeX
@article{mecfsatlas-mancini-2021-use-cardiopulmonary,
author = {Mancini, Donna M and Brunjes, Danielle L and Lala, Anuradha and Trivieri, Maria Giovanna and Contreras, Johanna P and Natelson, Benjamin H},
title = {Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post-Coronavirus Disease.},
journal = {JACC. Heart failure},
year = {2021},
doi = {10.1016/j.jchf.2021.10.002},
note = {PubMed: 34857177},
url = {https://www.mecfsatlas.com/evidence/mancini-2021-use-cardiopulmonary},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/mancini-2021-use-cardiopulmonary
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