Electrocardiographic Risk Stratification in COVID-19 Patients

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• The COVID-19 pandemic caused widespread global morbidity.
• Troponin elevation is common in hospitalized COVID-19 patients, indicating potential cardiac injury or stress.
• Understanding troponin's relationship with ECG changes and mortality is crucial for patient management.

Purpose of the Study:

• To assess the correlation between troponin elevation levels, electrocardiographic (ECG) abnormalities, and mortality in COVID-19 patients.
• To determine if ECG changes can refine risk stratification in COVID-19 patients with elevated troponin.
• To investigate the prognostic value of specific ECG repolarization abnormalities.

Main Methods:

• Retrospective analysis of 204 hospitalized COVID-19 patients.
• Evaluation of serial electrocardiogram (ECG) tracings and troponin levels.
• Analysis of mortality rates based on troponin ranges and presence of ECG changes (ST elevation, ST depression, T-wave inversion).

Main Results:

• Mortality increased progressively with higher troponin levels, reaching 60% when troponin exceeded 1 ng/ml.
• In patients with mild troponin elevation (0.05-1.00 ng/ml), ECG abnormalities, particularly T-wave inversions, were associated with significantly higher mortality.
• Specific ECG repolarization abnormalities correlated with increased mortality risk.

Conclusions:

• ECG repolarization abnormalities serve as a marker for clinical severity in COVID-19 patients with mild troponin elevation.
• Integrating ECG findings with troponin levels can enhance risk stratification for hospitalized COVID-19 patients.
• This approach may aid in identifying high-risk individuals needing closer monitoring and intervention.