Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter
Hugo De Carvalho1, Lucas Leonard-Pons2, Julien Segard3
1Department of Emergency Medicine SAMU44, 44000, Nantes, France.
Insights
Electrocardiogram (ECG) abnormalities like abnormal axis and left bundle branch block in COVID-19 patients presenting to the emergency department (ED) are linked to higher in-hospital mortality. These ECG findings can help identify at-risk patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause myocardial injury, but identifying at-risk patients and understanding cardiac involvement mechanisms in COVID-19 remains challenging.
- Elevated troponin levels during COVID-19 hospitalization are independently associated with increased in-hospital mortality and complications.
- Electrocardiographic (ECG) abnormalities may serve as a valuable tool for identifying COVID-19 patients at risk of poor prognosis.
Purpose of the Study:
- To investigate the relationship between specific electrocardiogram (ECG) patterns and in-hospital mortality in patients with COVID-19 presenting to the emergency department (ED).
- To assess the utility of ECG findings in predicting mortality risk among COVID-19 patients in a European setting.
Main Methods:
- A multicenter study conducted in three French hospitals from February 1st to May 31st, 2020, included adult COVID-19 patients with ECGs performed upon ED admission.
- Demographic data, comorbidities, drug exposures, clinical signs/symptoms, and outcomes were extracted from electronic medical records.
- Univariate and multivariable logistic regression analyses were employed to evaluate the association between ECG abnormalities and in-hospital mortality.
Main Results:
- ECG was performed on 275 COVID-19 patients; 87% had normal sinus rhythm, and 10% presented with atrial fibrillation/flutter.
- Repolarization abnormalities were the most frequent findings (40%), including negative T waves (21%).
- Abnormal axis (adjusted odds ratio: 3.9) and left bundle branch block (adjusted odds ratio: 7.1) were significantly associated with increased in-hospital mortality.
Conclusions:
- ECG analysis at ED admission can be a useful tool for predicting mortality in COVID-19 patients.
- The presence of an abnormal axis or left bundle branch block on ECG indicates a higher risk of in-hospital mortality for COVID-19 patients.
- ST segment elevation was infrequently observed in COVID-19 patients.
Background:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be associated with myocardial injury. Identification of at-risk patients and mechanisms underlying cardiac involvement in COVID-19 remains unclear. During hospitalization for COVID-19, high troponin level has been found to be an independent variable associated with in-hospital mortality and a greater risk of complications. Electrocardiographic (ECG) abnormalities could be a useful tool to identify patients at risk of poor prognostic. The aim of our study was to assess if specific ECGs patterns could be related with in-hospital mortality in COVID-19 patients presenting to the ED in a European country.
Methods:
From February 1st to May 31st, 2020, we conducted a multicenter study in three hospitals in France. We included adult patients (≥ 18 years old) who visited the ED during the study period, with ECG performed at ED admission and diagnosed with COVID-19. Demographic, comorbidities, drug exposures, signs and symptoms presented, and outcome data were extracted from electronic medical records using a standardized data collection form. The relationship between ECG abnormalities and in-hospital mortality was assessed using univariate and multivariable logistic regression analyses.
Results:
An ECG was performed on 275 patients who presented to the ED. Most of the ECGs were in normal sinus rhythm (87%), and 26 (10%) patients had atrial fibrillation/flutter on ECG at ED admission. Repolarization abnormalities represented the most common findings reported in the population (40%), with negative T waves representing 21% of all abnormalities. We found that abnormal axis (adjusted odds ratio: 3.9 [95% CI, 1.1-11.5], p = 0.02), and left bundle branch block (adjusted odds ratio: 7.1 [95% CI, 1.9-25.1], p = 0.002) were significantly associated with in-hospital mortality.
Conclusions:
ECG performed at ED admission may be useful to predict death in COVID-19 patients. Our data suggest that the presence of abnormal axis and left bundle branch block on ECG indicated a higher risk of in-hospital mortality in COVID-19 patients who presented to the ED. We also confirmed that ST segment elevation was rare in COVID-19 patients.
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