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Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19
Mustafa Yenerçağ1, Uğur Arslan1, Mustafa Doğduş2
1Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey.
Insights
Newly diagnosed COVID-19 patients show prolonged ventricular repolarization markers, including the Tp-e interval and Tp-e/QTc ratio. These changes correlate with C-reactive protein (CRP) levels, suggesting a potential risk for ventricular arrhythmias.
Area of Science:
- Cardiology
- Infectious Diseases
- Electrophysiology
Background:
- COVID-19 is a novel infectious disease linked to cardiovascular complications like arrhythmias.
- The precise mechanisms underlying ventricular arrhythmias in COVID-19 patients remain unclear.
Purpose of the Study:
- To investigate ventricular repolarization using electrocardiographic markers (Tp-e interval, QT dispersion, Tp-e/QT, Tp-e/QTc ratios) in COVID-19 patients.
- To assess the relationship between these repolarization parameters and C-reactive protein (CRP) levels.
Main Methods:
- Electrocardiographic parameters were analyzed in 75 newly diagnosed COVID-19 patients and 75 healthy controls.
- Measurements included Tp-e interval, QT intervals, dispersions, and their ratios.
- C-reactive protein (CRP) levels were measured in COVID-19 patients.
Main Results:
- COVID-19 patients exhibited significantly prolonged Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio compared to controls.
- A significant positive correlation was found between Tp-e interval, Tp-e/QTc ratio, and CRP levels.
- Two COVID-19 patients experienced ventricular tachycardia during treatment.
Conclusions:
- Electrocardiographic repolarization parameters (Tp-e interval, Tp-e/QT, Tp-e/QTc) are prolonged in newly diagnosed COVID-19 patients.
- These repolarization abnormalities correlate with CRP levels, indicating potential ventricular arrhythmia risk.
- Pre-treatment assessment of these parameters may aid in predicting ventricular arrhythmia risk in COVID-19 patients.
Introduction:
Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease that has spread rapidly. COVID-19 has been associated with a number of cardiovascular complications, including arrhythmias. The mechanism of ventricular arrhythmias in patients with COVID-19 is uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, QT dispersion, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with newly diagnosed COVID-19. In addition, the relationship between the repolarization parameters and the CRP (C-reactive protein) was investigated.
Methods:
75 newly diagnosed COVID-19 patients, 75 age and sex matched healthy subjects were included in the study between 20th March 2020 and 10th April 2020. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, Tp-e dispersion, corrected QT(QTc), QT dispersion (QTd), corrected QTd, Tp-e/QT and Tp-e/QTc ratios. CRP values were also measured in patients with newly diagnosed COVID-19.
Results:
Tp-e interval (80.7 ± 4.6 vs. 70.9 ± 4.8; p < .001), Tp-e / QT ratio (0.21 ± 0.01 vs. 0.19 ± 0.01; p < .001) and Tp-e/QTc ratio (0.19 ± 0.01 vs.0.17 ± 0.01; p < .001) were significantly higher in patients with newly diagnosed COVID-19 than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and CRP in patients with newly diagnosed COVID-19 (rs = 0.332, p = .005, rs = 0.397, p < .001 consecutively). During their treatment with hydroxychloroquine (HCQ), azithromycin and favipiravir, ventricular tachycardia episodes were observed in in two COVID-19 patients during their hospitalization in the intensive care unit.
Conclusion:
Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with newly diagnosed COVID-19, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and CRP. We believe that pre-treatment evaluation of repolarization parameters in newly diagnosed COVID-19 would be beneficial for predicting ventricular arrhythmia risk.
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