Electrocardiographic Features and Outcome: Correlations in 124 Hospitalized Patients With COVID-19 and Cardiovascular
Pavani Nathala1, Vidyulata Salunkhe1, Harideep Samanapally1
1Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases, University of Louisville, Louisville, KY.
Insights
Electrocardiogram (ECG) findings in hospitalized coronavirus disease 2019 (COVID-19) patients evolve during their illness. These changing ECG features correlate with cardiovascular events and patient outcomes, highlighting their clinical significance.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Electrocardiographic (ECG) changes are linked to coronavirus disease 2019 (COVID-19) severity.
- The progression of ECG findings throughout COVID-19 illness remains understudied.
Purpose of the Study:
- To characterize ECG features at various stages of COVID-19 cardiovascular (CV) events.
- To investigate the association between ECG parameters, cardiac biomarkers, and clinical outcomes in COVID-19 patients.
Main Methods:
- Retrospective cohort study involving 124 hospitalized patients with COVID-19 and CV events.
- Analysis of 12-lead ECG parameters, cardiac injury biomarkers, and clinical outcomes using correlation and ANOVA.
- Comparison of ECGs from admission, CV event time, and last hospital stay.
Main Results:
- Atrial fibrillation/flutter increased significantly from admission to CV event ECGs (9.5% vs 26.9%).
- Sinus tachycardia was more prevalent in later hospital ECGs compared to CV event ECGs (37.5% vs 20.4%).
- Admission ECG-corrected QT interval correlated with troponin levels (R=0.52). Nonsurvivors showed longer QRS duration on final ECGs (114.6 vs 91.2 ms). Higher heart rate correlated with longer ICU stays.
Conclusions:
- ECGs in hospitalized COVID-19 patients with CV events exhibit dynamic changes throughout hospitalization.
- These evolving ECG features demonstrate distinct correlations with clinical outcomes, underscoring their prognostic value.
Objectives:
Electrocardiographic (ECG) changes have been associated with coronavirus disease 2019 (COVID-19) severity. However, the progression of ECG findings in patients with COVID-19 has not been studied. The purpose of this study was to describe ECG features at different stages of COVID-19 cardiovascular (CV) events and to examine the effects of specific ECG parameters and cardiac-related biomarkers on clinical outcomes in COVID-19.
Design:
Retrospective, cohort study.
Setting:
Major tertiary-care medical centers and community hospitals in Louisville, KY.
Participants:
A total of 124 patients with COVID-19 and CV events during hospitalization.
Interventions:
None.
Measurements And Main Results:
Twelve-lead ECG parameters, biomarkers of cardiac injuries, and clinical outcomes were analyzed with Spearman correlation coefficients and Kruskal-Wallis 1-way analysis of variance. Atrial fibrillation/atrial flutter was more frequent on the ECG obtained at the time of the CV event when compared with admission ECG (9.5% v 26.9%; p = 0.007). Sinus tachycardia was higher in the last available hospital ECG than the CV event ECG (37.5% v 20.4%; p = 0.031). Admission ECG-corrected QT interval was significantly associated with admission troponin levels (R = 0.52; p < 0.001). The last available hospital ECG showed nonsurvivors had longer QRS duration than survivors (114.6 v 91.2 ms; p = 0.026), and higher heart rate was associated with longer intensive care unit length of stay (Spearman ρ = 0.339; p = 0.032).
Conclusions:
In hospitalized patients with COVID-19 and CV events, ECGs at various stages of COVID-19 hospitalization showed significantly different features with dissimilar clinical outcome correlations.
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