T-wave inversion as a manifestation of COVID-19 infection: a case series
Jorge Romero1, Isabella Alviz1, Michael Parides1
1Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, NY, USA.
Insights
New T-wave inversion (TWI) on electrocardiograms is common in COVID-19 patients. This finding, especially with elevated troponin, indicates a higher risk of mechanical ventilation and death.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 infection is associated with various cardiac complications, including elevated troponin, arrhythmias, and heart failure.
- T-wave inversion (TWI) is an electrocardiogram (ECG) finding that can indicate cardiac distress.
Purpose of the Study:
- To investigate the association between COVID-19 infection and T-wave inversion (TWI) in a large patient cohort.
- To determine the prognostic significance of TWI in COVID-19 patients.
Main Methods:
- An observational, retrospective study was conducted on confirmed COVID-19 cases with ECGs.
- Patients with new TWI or T-wave pseudonormalization were analyzed.
- Outcomes included mortality and the need for invasive mechanical ventilation.
Main Results:
- Of 3225 screened patients, 195 (6%) had new TWI or pseudonormalization.
- TWI was prevalent in lateral, anterior, inferior, and septal leads.
- Mortality rates were significantly higher in patients with diffuse TWI (35%) and elevated troponin (52%), reaching 80% when both were present.
Conclusions:
- New T-wave inversion is a frequent finding in COVID-19 patients.
- TWI or T-wave pseudonormalization, particularly when accompanied by elevated troponin, is linked to increased rates of mechanical ventilation and in-hospital mortality.
Purpose:
Cardiac involvement with COVID-19 infection has become evident by elevated troponin, cardiac arrhythmias, ST segment elevation, myocarditis, fulminant heart failure, and sudden cardiac death. We aimed to describe the association of COVID-19 and T-wave inversion (TWI) in a large case series.
Methods:
We conducted an observational, retrospective study of confirmed COVID-19 cases with at least one electrocardiogram (ECG) in a large hospital in New York City (March 23, 2020-April 23, 2020). Patients with new TWI or pseudonormalization were further analyzed. Mortality and the need for invasive mechanical ventilation were the main outcomes.
Results:
A total of 3225 patients were screened; 195 (6%) were selected for further analysis: 181 with TWI and 14 with T-wave pseudonormalization. Mean age was 66 ± 7 years; 51% were male. TWI were more commonly noted in the lateral (71%), followed by anterior (64%), inferior (57%), and septal (26%) leads. A total of 44 patients (23%) had elevated troponin. A total of 50 patients died (26%). Mortality rates of 35%, and 52% were observed in patients with diffuse TWI, and elevated troponin, respectively. Mortality rate of 80% was observed in patients with both elevated troponin and diffuse TWI. Additionally, 30% of the entire cohort and 58% of patients with elevated troponin required invasive mechanical ventilation.
Conclusion:
Our study demonstrates that new TWI is a relatively common finding in COVID-19 patients. Importantly, our findings suggest that new TWI or T-wave pseudonormalization, particularly with elevated troponin, was associated with higher rates of mechanical ventilation and in-hospital mortality.
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