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Madioko Makanzu B, Makulo JR, Ndona Mandina M, Wumba DR, Mashi Longokolo M, Situakibanza H, Odio O, Sonzi Mangala D, Mihigo Bashengezi C, Kabwe Mwilambwe B, Kabanda Kurhenga G, Longo-Mbenza B, Mwimba Mbungu R. Hydroxychloroquine-azithromycin, doubase C, and QTc prolongation in congolese patients with COVID-19: Myth or reality? World J Virol 2024; 13:90668. [DOI: 10.5501/wjv.v13.i2.90668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes (Tsd) has been described in coronavirus disease 2019 (COVID-19) patients treated with hydroxychloroquine (HCQ) and azithromycin (AZI) in Western countries. In the DR Congo, few studies have evaluated the safety of this association or proposed new molecules.
AIM To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C (new molecule).
METHODS In present randomized clinical trial, we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase C. Electrocardiogram (ECG) changes on day 14 of randomization were determined based on pretreatment tracing. Prolonged QTc was defined as ≥ 500 ms on day 14 or an increase of ≥ 80 ms compared to pretreatment tracing. Patients with cardiac disease, those undergoing other treatments likely to prolong QTc, and those with disturbed ECG tracings were excluded from the study.
RESULTS The study included 258 patients (mean age 41 ± 15 years; 52% men; 3.4% diabetics, 11.1% hypertensive). Mild and moderate COVID-19 were found in 93.5% and 6.5% of patients, respectively. At baseline, all patients had normal sinus rhythm, a mean heart rate 78 ± 13/min, mean PR space 170 ± 28 ms, mean QRS 76 ± 13 ms, and mean QTc 405 ± 30 ms. No complaints suggesting cardiac involvement were reported during or after treatment. Only four patients (1.5%) experienced QTc interval prolongation beyond 500 ms. Similarly, only five patients (1.9%) had an increase in the QTc interval of more than 80 ms. QTc prolongation was more significant in younger patients, those with high viral load at baseline, and those receiving HCQ-AZI (P < 0.05). None of the patients developed Tsd.
CONCLUSION QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase C. The absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.
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Affiliation(s)
- Brady Madioko Makanzu
- Department of Cardiology, Kinshasa University Hospital, Kinshasa, DR Congo, Kinshasa University Hospital, Kinshasa 11, Congo
| | - Jean-Robert Makulo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo, Kinshasa 11, Kinshasa, Congo
| | - Madone Ndona Mandina
- Department of Infectious Diseases, Kinshasa University Hospital, Kinshasa, DR Congo, Kinshasa 11, Congo
| | - Dimosi Roger Wumba
- Department of Tropical Medicine, University of Kinshasa, Kinshasa 11, Congo
| | | | - Hippolyte Situakibanza
- Department of Tropical Medicine and Infectious Disease, School of Medicine, University of Kinshasa, Kinshasa 11, Congo
| | - Ossam Odio
- Department of Infectious Diseases, Kinshasa University Hospital, Kinshasa, DR Congo, Kinshasa 11, Congo
| | - Donat Sonzi Mangala
- COVID-19 Treatment Center, Kinshasa University Hospital, Kinshasa, Kinshasa 11, Congo
| | | | | | - Gilbert Kabanda Kurhenga
- Department of Cardiology, Kinshasa University Hospital, Kinshasa, DR Congo, Kinshasa University Hospital, Kinshasa 11, Congo
| | - Benjamin Longo-Mbenza
- Department of Cardiology, Kinshasa University Hospital, Kinshasa, DR Congo, Kinshasa University Hospital, Kinshasa 11, Congo
| | - Roger Mwimba Mbungu
- Department of Gynecology and Obstetrics, Kinshasa University Hospital, Kinshasa 11, Congo
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Alsuhaibani DS, Edrees HH, Alshammari TM. The use and safety risk of repurposed drugs for COVID-19 patients: lessons learned utilizing the Food and Drug Administration's Adverse Event Reporting System. Saudi Pharm J 2023; 31:1360-1366. [PMID: 37304358 PMCID: PMC10232922 DOI: 10.1016/j.jsps.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives This study was designed to assess the disproportionality analyses of adverse drug reactions (ADRs) related to hydroxychloroquine and remdesivir and how ADR reporting fluctuated during the COVID-19 pandemic. Methods A retrospective observational study was conducted utilizing the Food and Drug Administration's Adverse Event Reporting System (FAERS) data between 2019 and 2021. The study was conducted in two phases. In the first phase, all reports associated with the drugs of interest were evaluated to assess all related adverse drug reactions. In the second phase, specific outcomes of interest (i.e., QT prolongation and renal and hepatic events) were determined to study their association with the drugs of interest. A descriptive analysis was conducted for all adverse reactions related to the drugs being studied. In addition, disproportionality analyses were conducted to compute the reporting odds ratio, the proportional reporting ratio, the information component, and the empirical Bayes geometric mean. All analyses were conducted using RStudio. Results A total of 9,443 ADR reports related to hydroxychloroquine; 6,160 (71.49) patients were female, and higher percentage of patients of both sexes were over the age of 65 years. QT prolongation (1.48%), pain (1.38%), and arthralgia (1.25%) were most frequently reported ADRs during the COVID-19 pandemic. The association of QT prolongation with use of hydroxychloroquine was statistically significant (ROR 47.28 [95% CI 35.95-62.18]; PRR 42.41 [95% CI 32.25-55.78]; EBGM 16.08; IC 4.95) compared with fluoroquinolone. The outcome was serious medical events in 48.01% of ADR reports; 27.42% required hospitalization and 8.61% resulted in death. Of 6,673 ADR reports related to remdesivir, 3,928 (61.13%) patients were male. During 2020, the top three ADR reports were elevated liver function tests (17.26%), acute kidney injury (5.95%) and death (2.84%). Additionally, 42.71% of ADR reports indicated serious medical events; 19.69% resulted in death and 11.71% indicated hospitalization. The ROR and PRR of hepatic and renal events associated with remdesivir were statistically significant, (4.81 [95% CI 4.46-5.19] and 2.96 [95% CI 2.66-3.29], respectively. Conclusion Our study showed that several serious ADRs were reported with the use of hydroxychloroquine, which resulted in hospitalization and death. Trends with the use of remdesivir were similar, but to a lesser extent. Therefore, this study showed us that off-label use should be based on thorough evidence-based evaluation.
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Affiliation(s)
- Deemah S Alsuhaibani
- Pharmaceutical Care Department, Medical Services for Armed Forces, Ministry of Defense, Riyadh, Saudi Arabia
| | - Heba H Edrees
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
- College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia
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Netiazhenko VZ, Mostovyi SE, Safonova OM. The Impact of COVID-19 upon Intracardiac Hemodynamics and Heart Rate Variability in Stable Coronary Artery Disease Patients. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2023. [DOI: 10.30702/ujcvs/23.31(01)/nm009-1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The aim. To study the impact of COVID-19 upon intracardiac hemodynamics and heart rate variability (HRV) in stable coronary artery disease (SCAD) patients.
Materials and methods. In this cross-sectional study we analyzed clinical and instrumental data obtained from a sample of 80 patients. The patients were divided into three groups: group 1 included patients with SCAD without COVID-19 (n=30), group 2 included patients with SCAD and COVID-19 (n=25), and group 3 included patients with COVID-19 without SCAD (n=25). The control group included 30 relatively healthy volunteers.
Results. The changes in intracardiac hemodynamics and HRV in group 2 were characterized by the impaired left ventricular systolic and diastolic function, dilation of both ventricles and elevated systolic pulmonary artery pressure. Left ventricular end-diastolic volume was higher in group 2 (205±21 ml) than that in group 1 (176±33 ml; р<0.001) and group 3 (130±21 ml; р<0.001). Patients in the groups 1–3, compared to controls, presented with the decrease in the overall HRV (by standard deviation [SD] of all NN intervals [SDNN]; SD of the averages of NN intervals in all 5 min segments of the entire recording; and mean of the SDs of all NN intervals for all 5 min segments of the entire recording) and parasympathetic activity (root-mean-square difference of successive NN intervals; the proportion derived by dividing the number of interval differences of successive NN intervals greater than 50 ms [NN50] by the total number of NN intervals [pNN50], and high frequency spectral component), along with QT interval prolongation and increase in its variability. Group 2 demonstrated the most advanced changes in HRV (by SDNN and pNN50) and both QT interval characteristics.
Conclusions. The patients with SCAD and concomitant COVID-19, along with both ventricles dilation and intracardiac hemodynamics impairment, presented with the sings of autonomic dysfunction, QT interval prolongation and increase in its variability. The heart rate variability and QT interval characteristics should be additionally considered in the management of such patients.
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Tondas AE, Munawar DA, Marcantoni I, Liberty IA, Mulawarman R, Hadi M, Trifitriana M, Indrajaya T, Yamin M, Irfannuddin I, Burattini L. Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device. Cardiol Res 2023; 14:45-53. [PMID: 36896221 PMCID: PMC9990541 DOI: 10.14740/cr1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/27/2022] [Indexed: 02/27/2023] Open
Abstract
Background Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology. Methods Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor® Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method. Results A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R2 = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33). Conclusions Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.
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Affiliation(s)
- Alexander Edo Tondas
- Department of Cardiology and Vascular Medicine, Mohammad Hoesin General Hospital, Palembang, Sumatera Selatan, Indonesia.,Biomedicine Doctoral Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Dian Andina Munawar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Cardiology, Lyell Mcewin Hospital, School of Medicine, The University of Adelaide, Australia
| | - Ilaria Marcantoni
- Department of Information Engineering, Universita Politecnica delle Marche, Ancona, Italy
| | | | - Rido Mulawarman
- Faculty of Medicine, Universitas Sriwijaya Palembang, Indonesia
| | - Muhammad Hadi
- Faculty of Medicine, Universitas Sriwijaya Palembang, Indonesia
| | | | - Taufik Indrajaya
- Cardiovascular Division, Department of Internal Medicine, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Muhammad Yamin
- Cardiovascular Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Laura Burattini
- Department of Information Engineering, Universita Politecnica delle Marche, Ancona, Italy
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Kovtyukh IV, Baymukanov AM, Gendlin GE, Nikitin IG, Dvornikova SN, Roginko O. Electrocardiogram QRS Complex Duration as a Predictor of Hospital Prognosis in Patients With COVID-19. KARDIOLOGIIA 2022; 62:30-37. [PMID: 36636974 DOI: 10.18087/cardio.2022.12.n2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/16/2022] [Indexed: 01/14/2023]
Abstract
Aim To determine the effect of major electrocardiographic (ECG) parameters on the prognosis of patients with COVID-19.Material and methods One of systemic manifestations of COVID-19 is heart injury. ECG is the most simple and available method for diagnosing the heart injury, which influences the therapeutic approach. This study included 174 hospitalized patients with COVID-19. Major ECG parameters recorded on admission and their changes before the discharge from the hospital or death of the patient, were analyzed, and the effect of each parameter on the in-hospital prognosis was determined. Results were compared with the left ventricular ejection fraction (LV EF), laboratory data, and results of multispiral computed tomography (MSCT) of the lungs.Results ECG data differed on admission and their changes differed for deceased and discharged patients. Of special interest was the effect of the QRS complex duration at baseline and at the end of treatment on the in-hospital survival and mortality rate. The Cox regression analysis showed that the QRS complex duration (relative risk (RR) 2.07, 95% confidence interval (CI): 1.17-3.66; р=0.01), MSCT data (RR, 1.54; 95 % CI: 1.14-2.092; р=0.005), and glomerular filtration rate (GFR) (RR, 0.98; 95 % CI: 0.96-0.99; р=0.001) had the highest predictive significance. In further comparison of these three indexes, the QRS duration and GFR retained their predictive significance, and a ROC analysis showed that the cut-off QRS complex duration was 125 ms (р=0.001). Patients who developed left bundle branch block (LBBB) in the course of disease also had an unfavorable prognosis compared to other intraventricular conduction disorders (р=0.038). The presence of LBBB was associated with reduced LV EF (р=0.0078). The presence of atrial fibrillation (AF) significantly predetermines a worse outcome both at the start (р=0.011) and at the end of observation (р=0.034). A higher mortality was observed for the group of deceased patients with ST segment deviations, ST elevation (р=0.0059) and ST depression (р=0.028).Conclusion Thus, the QTc interval elongation, LBBB that developed during the treatment, AF, and increased QRS complex duration are the indicators that determine the in-hospital prognosis of patients with COVID-19. The strongest electrocardiographic predictor for an unfavorable prognosis was the QRS complex duration that allowed stratification of patients to groups of risk.
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Affiliation(s)
- I V Kovtyukh
- Petrovsky Russian Scientific Center of Surgery, Moscow
| | | | - G E Gendlin
- ФГАОУ ВО "Российский национальный исследовательский медицинский университет имени Н.И. Пирогова" Минздрава России, Москва
| | - I G Nikitin
- Pirogov Russian National Research Medical University, Moscow
| | | | - Olga Roginko
- Petrovsky Russian Scientific Center of Surgery, Moscow
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Muacevic A, Adler JR. The Effect of COVID-19 on QTc Prolongation. Cureus 2022; 14:e29863. [PMID: 36204258 PMCID: PMC9528850 DOI: 10.7759/cureus.29863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme-2 receptors on host cells to enter the cells. These receptors are expressed on heart muscle tissue and the tissues of other major organs, which supports the primary accepted theory for the direct cardiac cell injury of coronavirus disease 2019 (COVID-19) and the associated cardiorespiratory manifestations. The SARS-CoV-2 infection leads to unstable myocardial cell membranes due to hypoxia, myocarditis, myocardial ischemia, and abnormal host immune response. This is the main reason behind arrhythmia and electrocardiogram (ECG) changes during COVID-19. However, the specific effect on QTc has not been studied well. Therefore, this study aimed to examine the association between COVID-19 and QTc changes. Methodology We conducted an observational, retrospective review of hospital medical records of 320 adult participants diagnosed with COVID-19 at our facility. After applying the exclusion criteria, 130 participants were included and distributed into two groups. One group had long QTc, and one group had normal QTc. Data were collected and recorded using Microsoft Excel. We used SPSS Statistics for Windows, Version 20.0. (IBM Corp., Armonk, NY, USA) to analyze the data. Student's t-tests were performed for independent groups. Quantitative data were summarized using mean and standard deviation. Statistical significance was taken as p < 0.05. Results A total of 63 (48.4%) participants met the criteria for long QTc, and 67 (51.5%) participants had normal QTc (p < 0.001). There was no statistically significant difference in mortality outcomes between long QTc and normal QTc (0.8% vs. 3.8%, respectively; p = 0.21). Conclusions This study aimed to examine the association between COVID-19 and QTc changes. Nearly half of the participants had an increased QTc with COVID-19, and QTc length was not associated with mortality outcomes. Our results indicate that COVID-19 is an independent risk factor for QTc prolongation on ECG. Identifying COVID-19 as an independent risk factor for QTc prolongation is a clinically significant finding, and physicians should consider this when treating cardiac patients and possible COVID-19-positive patients.
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Carubbi F, Alunno A, Carducci A, Grassi D, Ferri C. Electrocardiographic Abnormalities in Hospitalized Patients with COVID-19 and the Associations with Clinical Outcome. J Clin Med 2022; 11:jcm11175248. [PMID: 36079177 PMCID: PMC9457256 DOI: 10.3390/jcm11175248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
The cardiovascular (CV) system can often be affected during SARS-CoV-2 infection and several acute manifestations, such as myocardial infarction, pericarditis, myocarditis and arrhythmias have been described. We provide a retrospective overview of electrocardiographic (ECG) features and their relationship with clinical outcomes in a cohort of patients admitted to our COVID-19 Unit between November 2020 and May 2021. Resting standard 12-lead ECGs were performed in all patients at admission and in those recovering from SARS-CoV-2 infection also at discharge. Clinical and serological records alongside ECG measurements were retrospectively evaluated and statistical analysis was performed to identify relationships between variables. A total of 123 patients (44% females) with a mean age of 73.9 years were enrolled. Ninety-five (77%) patients recovered from SARS-CoV-2 infection and were discharged while 28 (23%) died in hospital. Almost 90% of patients displayed at least one CV risk factor and 41 (33%) patients had at least one previous CV event. We observed that heart rate, corrected QT interval dispersion (QTcd) and inverted T waves are independently associated with in-hospital death and inverted T waves show the strongest association. This association remained significant even after correcting for the number of CV risk factors at baseline and for the type of CV risk factor at baseline. Our study demonstrated that some ECG abnormalities at admission are independently associated with in-hospital death regardless of pre-existing CV risk factors. These findings may be of particular relevance in clinical settings with limited access to advanced techniques, such as cardiac magnetic resonance and could help improve the outcomes of patients with cardiac involvement related to SARS-CoV-2 infection.
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Affiliation(s)
- Francesco Carubbi
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Augusto Carducci
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Davide Grassi
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy
- Correspondence:
| | - Claudio Ferri
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy
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El Nekidy WS, Almuti K, ElRefaei H, Atallah B, Mohammad LM, AlMahmeed W, Badr M, Abdallah K, Hamed F, Mallat J. QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection. J Cardiovasc Pharmacol Ther 2022; 27:10742484211069479. [PMID: 35006023 DOI: 10.1177/10742484211069479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population. METHODS We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms). RESULTS Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation (P = .004 for the likelihood-ratio test). CONCLUSION The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.
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Affiliation(s)
- Wasim S El Nekidy
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Khalid Almuti
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Hazem ElRefaei
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bassam Atallah
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Lana M Mohammad
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Gulf Medical University, Ajman, United Arab Emirates
| | - Wael AlMahmeed
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohamed Badr
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697West Hertfordshire NHS Trust, Watford, United Kingdom
| | - Khaled Abdallah
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Fadi Hamed
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jihad Mallat
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Normandy University, Caen, France
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Rosén J, Noreland M, Stattin K, Lipcsey M, Frithiof R, Malinovschi A, Hultström M. ECG pathology and its association with death in critically ill COVID-19 patients, a cohort study. PLoS One 2021; 16:e0261315. [PMID: 34905575 PMCID: PMC8670711 DOI: 10.1371/journal.pone.0261315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We investigated the prevalence of ECG abnormalities and their association with mortality, organ dysfunction and cardiac biomarkers in a cohort of COVID-19 patients admitted to the intensive care unit (ICU). METHODS This cohort study included patients with COVID-19 admitted to the ICU of a tertiary hospital in Sweden. ECG, clinical data and laboratory findings during ICU stay were extracted from medical records and ECGs obtained near ICU admission were reviewed by two independent physicians. RESULTS Eighty patients had an acceptable ECG near ICU-admission. In the entire cohort 30-day mortality was 28%. Compared to patients with normal ECG, among whom 30-day mortality was 16%, patients with ECG fulfilling criteria for prior myocardial infarction had higher mortality, 63%, odds ratio (OR) 9.61 (95% confidence interval (CI) 2.02-55.6) adjusted for Simplified Acute Physiology Score 3 and patients with ST-T abnormalities had 50% mortality and OR 6.05 (95% CI 1.82-21.3) in univariable analysis. Both prior myocardial infarction pattern and ST-T pathology were associated with need for vasoactive treatment and higher peak plasma levels of troponin-I, NT-pro-BNP (N-terminal pro-Brain Natriuretic Peptide), and lactate during ICU stay compared to patients with normal ECG. CONCLUSION ECG with prior myocardial infarction pattern or acute ST-T pathology at ICU admission is associated with death, need for vasoactive treatment and higher levels of biomarkers of cardiac damage and strain in severely ill COVID-19 patients, and should alert clinicians to a poor prognosis.
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Affiliation(s)
- Jacob Rosén
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Maria Noreland
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Karl Stattin
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Hedenstierna laboratory, CIRRUS, Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
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Puttegowda B, Shivashankarappa AB, Dutta S, Chikkamuniswamy R, Bhat P, Krishnan S, Nanjappa MC. Patterns of cardiovascular diseases in COVID-19 patients admitted to tertiary cardiac care centre. Indian Heart J 2021; 73:682-686. [PMID: 34695446 PMCID: PMC8532374 DOI: 10.1016/j.ihj.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives To analyse the pattern of cardiovascular diseases (CVDs) in COVID-19 patients admitted to tertiary cardiac care centre. Methods We retrospectively analysed 511 adult patients admitted between July 1, 2020, and November 30, 2020, with COVID-19 infection and having either new onset or pre-existing CVDs. Clinical features, electrocardiogram (ECG), echocardiography, chest X-ray, biomarkers, haematological and biochemical parameters were analysed. Results The mean age of the patients was 56.62 ± 14.74 years. Male: Female ratio was 2.78:1. Pre-existing CVDs were present in 258 patients (50.5%). The most common cardiovascular manifestation was acute coronary syndrome (ACS), seen in 259 patients (50.7%). ST-segment elevation myocardial infarction (STEMI) was more common than non-ST-segment elevation ACS (NSTE-ACS). Possible myocarditis was seen in 52 patients (10.1%). Rhythm and conduction abnormalities were noted in 144 patients (28.2%), the most common being QT prolongation, seen in 51 patients (10%). In-hospital mortality occurred in 97 patients (18.9%). Age, serum Ferritin level, D-dimer, NT-pro-BNP and total leukocyte count were significantly higher among patients with in-hospital mortality compared to survival group. Blood lymphocyte count and Haemoglobin level were significantly lower in mortality-group, compared to survival-group. Incidence of pre-existing CVDs, cardiogenic shock, heart failure, atrial fibrillation (AF), and renal failure were significantly higher in mortality-group compared to survival-group. Conclusion The most common CVD in COVID-19 patients in our study was ACS. STEMI was more common than NSTE-ACS. Advanced age, elevated serum ferritin, D-dimer, NT pro-BNP, leucocytosis, lymphopenia, lower haemoglobin, pre-existing CVDs heart failure, cardiogenic shock, AF and renal failure were associated with increased mortality in these patients.
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Affiliation(s)
- Beeresha Puttegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Arun B Shivashankarappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
| | - Suvradip Dutta
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Rama Chikkamuniswamy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Prabhavathi Bhat
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Shanmugum Krishnan
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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11
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Muhammad M, Emin M, Bhutta A, Gul EH, Voorhees E, Afzal MR. Cardiac arrhythmias associated with COVID-19 infection: state of the art review. Expert Rev Cardiovasc Ther 2021; 19:881-889. [PMID: 34702128 PMCID: PMC8607535 DOI: 10.1080/14779072.2021.1997589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION COVID-19 infection is associated with many different systemic complications. Among these, cardiovascular system complications are particularly important as these are associated with significant mortality. There are many different subgroups of cardiovascular complications, with Arrhythmias being one of them. Arrhythmias are especially important as there are a substantial percentage of patients who have arrhythmia after a COVID-19 infection, and these patients are seen with an increased mortality rate. The main interest of this review is understanding some of the specific post-COVID-19 arrhythmic complications and their predisposing factors. AREAS COVERED This paper will highlight the findings of studies on cardiovascular system disease after COVID-19 infection, different specific arrhythmic complications of COVID-19, and changes in electrophysiologic interventions post-COVID-19 outbreak in different centers around the world. An extensive literature search was made to find pertinent articles. EXPERT OPINION Studies show us that a significant percentage of COVID-19 patients have arrhythmia. Many distinct types of arrhythmias are associated with COVID-19 infection, and specific risk factors of these arrhythmias are important as this information can be used to detect and prioritize certain at-risk patients for early treatment, which can mean life or death in some cases.
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Affiliation(s)
- Marwan Muhammad
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Mustafa Emin
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Ayat Bhutta
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Essa H. Gul
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Elijah Voorhees
- Department of Internal Medicine, Kent State University, Kent, Ohio, USA
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
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12
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Jang SW. QTc Dispersion Predicts Prognosis in COVID-19 Disease. Korean Circ J 2021; 51:863-865. [PMID: 34595854 PMCID: PMC8484998 DOI: 10.4070/kcj.2021.0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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AYDEMİR S, ŞAHAN E. The role of ECG as a mortality predictor in COVID-19 patients treated in the intensive care unit. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.980551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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