ECG markers of malignant arrhythmias and in-hospital outcome of COVID-19 pneumonia

The relationship between length of stay in intensive care unit and Tpeak‐Tend and Tpeak‐Tend/QTc ratio in COVID 19 patients with acute coronary syndrome

Background

Patients with coronavirus disease 2019 (COVID‐19) can develop cardiac injury resulting in cardiac arrhythmias, myocarditis, and acute coronary syndrome (ACS). In this study, we aimed to investigate whether COVID‐19 infection affects ventricular repolarization parameters such as Tpeak‐Tend interval (Tp‐e), QT interval, corrected QT (QTc), Tp‐e/QT, and Tp‐e/cQT in patients with ACS.

Methods

The study consisted of two groups. The first group included patients with ACS and COVID‐19 (Group 1) (n = 50). Polymerase chain reaction test positive patients were enrolled. The second group included patients with only ACS (Group 2) (n = 100). The risk of ventricular arrhythmias was evaluated on the basis of the measured electrocardiographic Tp‐e and QT interval, and QTc, Tp‐e/QT, and Tp‐e/QTc values.

Results

Tp‐e interval, QTc, and Tp‐e/QTc were significantly higher in the group1 than group 2 (p < .001, p < .018, and p < .001, respectively). Significant positive correlations were found between Tp‐e, D‐dimer level, and C‐reactive protein (CRP) level in the group1 (p = .002, p = 0 .03, and p = .021, respectively). Univariate and multivariate regression analyses revealed that Tp‐e was one of the independent predictor of length of stay in the intensive care unit (ICU). (B = 1.662, p = .006 and B = 1.804, p = .021, respectively).

Conclusions

In the patients with ACS, COVID‐19 infection caused increases in QTc, Tp‐e, and Tp‐e/QTc ratio. In addition, age and prolonged Tp‐e were found to be independent predictors of prolonged ICU stay.

Arrhythmias in COVID-19/SARS-CoV-2 Pneumonia Infection: Prevalence and Implication for Outcomes

Arrhythmias (ARs) are potential cardiovascular complication of COVID-19 but may also have a prognostic role. The aim of this study was to explore the prevalence and impact of cardiac ARs in hospitalized COVID-19 patients. All-comer patients admitted to the emergency department of Modena University Hospital from 16 March to 31 December 2020 and diagnosed with COVID-19 pneumonia infection were included in the study. The primary endpoint was 30-day mortality. Out of 902 patients, 637 (70.6%) presented a baseline 12-lead ECG registration; of these, 122 (19.2%) were diagnosed with ARs. Atrial fibrillation (AF, 40.2%) was the most frequent AR detected. The primary endpoint (30-day mortality) occurred in 33.6% (p < 0.001). AR-patients presented an almost 3-fold risk of mortality compared to non-AR-patients at 30d (Adj. OR = 2.8, 95%CI: 1.8−4.3, p < 0.001). After adjustment for significant baseline characteristics selected by a stepwise backward selection, AR-patients remained at increased risk of mortality (Adj. HR = 2.0, 95%CI: 1.9−2.3, p < 0.001). Sub-group analysis revealed that among ARs patients, those with AF at admission presented the highest risk of 30-day mortality (Adj. HR = 3.1, 95%CI: 2.0−4.9, p < 0.001). In conclusion, ARs are a quite common manifestation in COVID-19 patients, who are burdened by even worse prognosis. AR patients with AF presented the highest risk of mortality; thus, these patients may benefit from a more aggressive secondary preventive therapy and a closer follow up.

The role of admission electrocardiogram in predicting outcome in patients hospitalized for COVID-19

BACKGROUND

Abnormal electrocardiogram (ECG) has been associated with poor outcome in patients hospitalized for COVID-19. However, the independent association between admission ECG and the risk of a poor outcome remains to be established. Our aim was to determine if abnormal admission ECG predicts treatment at intensive care unit or in-hospital death within 30 days in patients hospitalized for COVID-19.

METHODS

We analyzed the propensity weighted association between abnormal admission ECG and outcome in patients hospitalized for COVID-19 (March to May 2020). All adult patients hospitalized for COVID-19 at the three centers of Sahlgrenska University Hospital (Gothenburg, Sweden) were eligible for inclusion (N = 439). Patients with available admission ECG within six hours from admission were included.

RESULTS

238 patients (age 62 ± 16 years, 74% male) were included. 103 patients had normal ECG and 135 patients had abnormal ECG. 99 patients were admitted to intensive care unit or died in-hospital within 30 days. Abnormal ECG was associated with increased risk of the outcome (odds ratio 2.11 [95% confidence interval 1.21-3.66]).

CONCLUSIONS

Abnormal admission ECG was associated with increased risk of treatment at intensive care unit or in-hospital death within 30 days; and could be considered a high-risk criterion in patients hospitalized for COVID-19.

J-waves in acute COVID-19: A novel disease characteristic and predictor of mortality?

Background

J-waves represent a common finding in routine ECGs (5–6%) and are closely linked to ventricular tachycardias. While arrhythmias and non-specific ECG alterations are a frequent finding in COVID-19, an analysis of J-wave incidence in acute COVID-19 is lacking.

Methods

A total of 386 patients consecutively, hospitalized due to acute COVID-19 pneumonia were included in this retrospective analysis. Admission ECGs were analyzed, screened for J-waves and correlated to clinical characteristics and 28-day mortality.

Results

J-waves were present in 12.2% of patients. Factors associated with the presence of J-waves were old age, female sex, a history of stroke and/or heart failure, high CRP levels as well as a high BMI. Mortality rates were significantly higher in patients with J-waves in the admission ECG compared to the non-J-wave cohort (J-wave: 14.9% vs. non-J-wave 3.8%, p = 0.001). After adjusting for confounders using a multivariable cox regression model, the incidence of J-waves was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15–6.63; p = 0.023). J-waves disappeared or declined in 36.4% of COVID-19 survivors with available ECGs for 6–8 months follow-up.

Conclusion

J-waves are frequently and often transiently found in the admission ECG of patients hospitalized with acute COVID-19. Furthermore, they seem to be an independent predictor of 28-day mortality.