ECG changes in hospitalised patients with COVID-19 infection
Mengshi Yuan1, Zafraan Zathar2, Frantisek Nihaj3
1Cardiology Registar Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH.
Insights
New electrocardiogram (ECG) abnormalities in COVID-19 patients indicate a higher risk of in-hospital death. These ECG changes are significant predictors of mortality in coronavirus disease 2019 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Coronavirus disease 2019 (COVID-19) primarily affects the respiratory system.
- Cardiovascular complications of COVID-19 are increasingly recognized.
- Electrocardiogram (ECG) abnormalities may indicate cardiac involvement in COVID-19 patients.
Purpose of the Study:
- To assess the prevalence and significance of electrocardiogram (ECG) abnormalities in patients diagnosed with COVID-19.
- To determine if ECG abnormalities are associated with in-hospital mortality in COVID-19 patients.
Main Methods:
- Retrospective analysis of a hospital's COVID-19 database (April-May 2020).
- Defined ECG abnormalities included new sinus bradycardia, bundle-branch block, heart block, arrhythmias, atrial fibrillation/flutter, ventricular tachycardia, and ischemic changes.
- Compared outcomes between patients with and without any ECG abnormality.
Main Results:
- Of 455 COVID-19 patients, 59 (12.8%) exhibited ECG abnormalities.
- Patients with ECG abnormalities were older (77.8 vs. 67.4 years) and had higher in-hospital mortality (44.1% vs. 27.8%).
- ECG abnormalities, advanced age, elevated troponin I, and low estimated glomerular filtration rate (eGFR) independently predicted in-hospital mortality.
Conclusions:
- New electrocardiogram (ECG) abnormalities are a significant independent predictor of in-hospital mortality in COVID-19 patients.
- Cardiac monitoring, including ECGs, is crucial for managing COVID-19 patients.
- Identifying ECG changes can aid in risk stratification and timely intervention for critically ill patients.
Abstract:
The coronavirus disease 2019 (COVID-19) commonly involves the respiratory system but increasingly cardiovascular involvement is recognised. We assessed electrocardiogram (ECG) abnormalities in patients with COVID-19. We performed retrospective analysis of the hospital's COVID-19 database from April to May 2020. Any ECG abnormality was defined as: 1) new sinus bradycardia; 2) new/worsening bundle-branch block; 3) new/worsening heart block; 4) new ventricular or atrial bigeminy/trigeminy; 5) new-onset atrial fibrillation (AF)/atrial flutter or ventricular tachycardia (VT); and 6) new-onset ischaemic changes. Patients with and without any ECG change were compared. There were 455 patients included of whom 59 patients (12.8%) met criteria for any ECG abnormality. Patients were older (any ECG abnormality 77.8 ± 12 years vs. no ECG abnormality 67.4 ± 18.2 years, p<0.001) and more likely to die in-hospital (any ECG abnormality 44.1% vs. no ECG abnormality 27.8%, p=0.011). Coxproportional hazard analysis demonstrated any ECG abnormality (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.12 to 3.47, p=0.019), age (HR 1.03, 95%CI 1.01 to 1.05, p=0.0009), raised high sensitivity troponin I (HR 2.22, 95%CI 1.27 to 3.90, p=0.006) and low estimated glomerular filtration rate (eGFR) (HR 1.73, 95%CI 1.04 to 2.88, p=0.036) were independent predictors of in-hospital mortality. In conclusion, any new ECG abnormality is a significant predictor of in-hospital mortality.
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