Electrocardiographic QRS axis shift, rotation and COVİD-19

Area of Science:

• Cardiology
• Pulmonology
• Medical Imaging

Background:

• Severe dyspnea is a critical complication of coronavirus disease-2019 (COVID-19).
• Electrocardiographic frontal QRS axis rightward shift (Rws) and clockwise rotation (Cwr) can occur with severe respiratory compromise.

Purpose of the Study:

• To investigate the predictability of advanced lung tomography findings using QRS axis shift and rotation in COVID-19 patients.
• To correlate electrocardiographic findings with tomographic staging and clinical parameters.

Main Methods:

• Retrospective analysis of 160 COVID-19 patients, divided into normal (n=80) and low (n=80) oxygen saturation groups.
• Further stratification based on electrocardiographic rightward (Rws) and leftward (Lws) axis shifts.
• Comparison of groups based on electrocardiographic rotation, tomographic stage (CO-RADS), electrocardiographic intervals, and laboratory findings.

Main Results:

• In patients with low oxygen saturation, Rws and Cwr were significantly higher compared to the Lws group.
• No significant differences in these parameters were observed between Rws and Lws groups in patients with normal oxygen saturation.
• Logistic regression indicated that Cwr and Rws independently increased the risk of advanced lung disease (CO-RADS5) by 18.9 and 4.6 fold, respectively, in hypoxemic patients.

Conclusions:

• Electrocardiographic Cwr and Rws are valuable predictors of advanced lung disease in COVID-19 patients with dyspnea and low oxygen saturation.
• These electrocardiographic findings demonstrated good sensitivity (80%) and specificity (80%) for predicting advanced lung tomographic findings in this patient cohort.