Electrocardiogram abnormalities and prognosis in COVID-19
Gabriel Chevrot1, Marie Hauguel-Moreau1,2, Marion Pépin2,3
1Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France.
Insights
Electrocardiogram (ECG) abnormalities are common in COVID-19 patients, particularly those who do not survive. Specific ECG findings like left bundle branch block and S1Q3 pattern at admission indicate a higher risk of death.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- COVID-19 poses significant cardiovascular risks, yet electrocardiogram (ECG) changes are understudied.
- Understanding ECG modifications in COVID-19 is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence and significance of electrocardiogram (ECG) abnormalities in COVID-19 patients.
- To determine if specific ECG findings can predict mortality in COVID-19.
Main Methods:
- Retrospective analysis of 669 COVID-19 patients admitted between January and December 2020.
- Systematic review of electrocardiogram (ECG) data at admission and during hospitalization.
- Multivariate analysis to identify independent predictors of mortality.
Main Results:
- 71.4% of patients had abnormal ECGs at admission, with higher rates in non-survivors (88.8%).
- Key predictors of death included left anterior fascicular block, bundle branch blocks, and S1Q3 pattern.
- New ECG abnormalities during hospitalization, such as repolarization changes and supraventricular arrhythmias, also correlated with increased mortality.
Conclusions:
- Electrocardiogram (ECG) abnormalities are frequent in COVID-19 patients and valuable for risk stratification.
- Clinicians should utilize ECG findings to assess prognosis and guide management in COVID-19 cases.
Background:
COVID-19 is a major pandemic with potential cardiovascular complications. Few studies have focused on electrocardiogram (ECG) modifications in COVID-19 patients.
Method And Results:
We reviewed from our database all patients referred to our hospital for COVID-19 between January 1st, 2020, and December 31st, 2020: 669 patients were included and 98 patients died from COVID-19 (14.6%). We systematically analyzed ECG at admission and during hospitalization if available. ECG was abnormal at admission in 478 patients (71.4%) and was more frequently abnormal in patients who did not survive (88.8 vs. 68.5%, p < 0.001). The most common ECG abnormalities associated with death were left anterior fascicular block (39.8 vs. 20.0% among alive patients, p < 0.001), left and right bundle branch blocks (p = 0.002 and p = 0.02, respectively), S1Q3 pattern (14.3 vs. 6.0%, p = 0.006). In multivariate analysis, at admission, the presence of left bundle branch block remained statistically related to death [OR = 3.82, 95% confidence interval (CI): 1.52-9.28, p < 0.01], as well as S1Q3 pattern (OR = 3.17, 95% CI: 1.38-7.03, p < 0.01) and repolarization abnormalities (OR = 2.41, 95% CI: 1.40-4.14, p < 0.01).On ECG performed during hospitalization, the occurrence of new repolarization abnormality was significantly related to death (OR = 2.72, 95% CI: 1.14-6.54, p = 0.02), as well as a new S1Q3 pattern (OR = 13.23, 95% CI: 1.49-286.56, p = 0.03) and new supraventricular arrhythmia (OR = 3.8, 95% CI: 1.11-13.35, p = 0.03).
Conclusion:
The presence of abnormal ECG during COVID-19 is frequent. Physicians should be aware of the usefulness of ECG for risk stratification during COVID-19.
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