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Electrocardiographic Manifestations in Patients with COVID-19: Daegu in South Korea
Han-Joon Bae1, Hyun Jun Cho2, Chan-Hee Lee3
1Division of Cardiology, Daegu Catholic University College of Medicine, Daegu, Korea.
Insights
Electrocardiogram (ECG) abnormalities, including prolonged corrected QT (QTc) and Tpe intervals, are linked to cardiac injury in COVID-19 patients. Increased QTc dispersion is a significant predictor of mortality in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- COVID-19 poses a significant risk of cardiac injury.
- Understanding ECG changes in COVID-19 is crucial for patient management.
Purpose of the Study:
- To investigate the impact of ECG parameters on COVID-19 disease severity.
- To identify ECG predictors of mortality in COVID-19 patients.
Main Methods:
- Analysis of 267 COVID-19 patients from seven medical centers.
- Evaluation of biochemical markers (CRP, NT-proBNP, cardiac enzymes) and ECG parameters (heart rate, PR, QRS, QT, Tpe intervals).
- Comparison of ECG findings across mild, moderate, and severe COVID-19 cases and between survivors and non-survivors.
Main Results:
- Severe COVID-19 cases showed elevated CRP, NT-proBNP, and cardiac enzymes.
- Prolonged corrected QT (QTc) and Tpe intervals were observed in severe cases.
- Increased QTc and Tpe dispersion were significantly associated with mortality, with QTc dispersion > 56.1 ms predicting mortality (OR 11.55).
Conclusions:
- COVID-19 can cause cardiac injury, particularly affecting cardiac repolarization.
- Prolonged QTc dispersion is an independent predictor of mortality in COVID-19 patients.
Background And Objectives:
As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients.
Methods:
Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]).
Results:
Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746-42.306).
Conclusions:
COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.
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