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Corrected QT interval in hospitalized patients with coronavirus disease 2019: Focus on drugs therapy
Jiaxing Ding1, Wei Liu, Hongquan Guan
1Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
QTc interval prolongation, linked to poor prognosis, was observed in COVID-19 patients. Certain drugs like chloroquine/hydroxychloroquine increased QTc prolongation risk, while Qingfei Paidu decoction showed a protective effect.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Corrected QT (QTc) interval prolongation is a known risk factor for adverse patient outcomes.
- Coronavirus disease 2019 (COVID-19) presents complex cardiovascular challenges.
- Understanding drug effects on cardiac repolarization is crucial for managing COVID-19 patients.
Purpose of the Study:
- To investigate the association between COVID-19 severity and QTc interval prolongation.
- To evaluate the impact of various medications used in COVID-19 treatment on QTc interval.
- To assess the relationship between cardiac injury biomarkers and QTc prolongation in COVID-19.
Main Methods:
- Retrospective analysis of 395 COVID-19 patients treated with chloroquine/hydroxychloroquine (CQ/HCQ), lopinavir/ritonavir (LPV/r), quinolones, interferon, Arbidol, or Qingfei Paidu decoction (QPD).
- Electrocardiograms were performed post-drug administration to measure QTc intervals.
- Statistical analysis, including odds ratios and correlation coefficients, was used to determine drug effects and associations with cardiac biomarkers.
Main Results:
- QTc prolongation (≥470 ms) occurred in 12.9% of patients and was linked to increased COVID-19 severity and mortality (P < .001).
- CQ/HCQ, LPV/r, and quinolones significantly increased the risk of QTc prolongation (P < .05).
- Arbidol, interferon, and QPD did not elevate QTc prolongation risk; QPD was associated with shorter QTc intervals (P = .042).
- QTc interval positively correlated with cardiac biomarkers: creatine kinase-MB, high-sensitivity troponin I, and B-type natriuretic peptide (P < .05).
Conclusions:
- QTc prolongation is a significant finding in COVID-19, associated with disease severity and mortality.
- Specific antiviral and antimalarial drugs (CQ/HCQ, LPV/r, quinolones) elevate QTc prolongation risk.
- Qingfei Paidu decoction appears to have a neutral or potentially protective effect on QTc interval in COVID-19 patients.
Abstract:
Corrected QT (QTc) interval prolongation has been associated with poor patient prognosis. In this study, we assessed the effects of different drugs and cardiac injury on QTc interval prolongation in patients with coronavirus disease 2019 (COVID-19).The study cohort consisted of 395 confirmed COVID-19 cases from the Wuhan Union Hospital West Campus. All hospitalized patients were treated with chloroquine/hydroxychloroquine (CQ/HCQ), lopinavir/ritonavir (LPV/r), quinolones, interferon, Arbidol, or Qingfei Paidu decoction (QPD) and received at least 1 electrocardiogram after drug administration.Fifty one (12.9%) patients exhibited QTc prolongation (QTc ≥ 470 ms). QTc interval prolongation was associated with COVID-19 severity and mortality (both P < .001). Administration of CQ/HCQ (odds ratio [OR], 2.759; 95% confidence interval [CI], 1.318-5.775; P = .007), LPV/r (OR, 2.342; 95% CI, 1.152-4.760; P = .019), and quinolones (OR, 2.268; 95% CI, 1.171-4.392; P = .015) increased the risk of QTc prolongation. In contrast, the administration of Arbidol, interferon, or QPD did not increase the risk of QTc prolongation. Notably, patients treated with QPD had a shorter QTc duration than those without QPD treatment (412.10 [384.39-433.77] vs 420.86 [388.19-459.58]; P = .042). The QTc interval was positively correlated with the levels of cardiac biomarkers (creatine kinase-MB fraction [rho = 0.14, P = .016], high-sensitivity troponin I [rho = .22, P < .001], and B-type natriuretic peptide [rho = 0.27, P < .001]).In conclusion, QTc prolongation was associated with COVID-19 severity and mortality. The risk of QTc prolongation was higher in patients receiving CQ/HCQ, LPV/r, and quinolones. QPD had less significant effects on QTc prolongation than other antiviral agents.
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