Significance and Usefulness of High-Resolution 24-h Electrocardiographic Parameters in Patients With Coronavirus
Motohiro Kimata1, Kenichi Hashimoto1,2, Naomi Harada2
1Department of General Medicine National Defense Medical College Saitama Japan.
Insights
Ambulatory electrocardiographic markers (AECG-Ms) can predict COVID-19 severity. T-wave alternans positivity indicates a higher risk of fatal events in coronavirus disease 2019 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Technology
Background:
- Coronavirus disease 2019 (COVID-19) can lead to severe outcomes, including cardiac complications.
- Predicting disease severity in COVID-19 patients is crucial for timely intervention.
- Ambulatory electrocardiographic markers (AECG-Ms) show prognostic value for cardiac events.
Purpose of the Study:
- To investigate ambulatory electrocardiographic markers (AECG-Ms) as predictors of COVID-19 disease severity.
- To correlate AECG-Ms with echocardiography and laboratory parameters in COVID-19 patients.
- To assess the prognostic value of AECG-Ms for fatal events in COVID-19.
Main Methods:
- A prospective cohort study involving 70 COVID-19 patients.
- 24-hour Holter electrocardiogram monitoring to measure AECG-Ms within 48 hours of admission.
- Echocardiography and laboratory tests were performed concurrently.
Main Results:
- T-wave alternans (TWA) positivity was significantly higher in the fatal event group (all-cause mortality, ventricular tachycardia/fibrillation).
- Kaplan-Meier survival analysis at 30 days showed significantly worse survival rates for TWA and late potential positive groups.
- AECG-Ms were frequently positive even in COVID-19 patients without apparent cardiac disease.
Conclusions:
- Ambulatory electrocardiographic markers (AECG-Ms) are valuable predictors of disease severity and prognosis in COVID-19.
- T-wave alternans positivity is associated with increased risk of fatal outcomes in COVID-19 patients.
- AECG-Ms offer a rapid, non-invasive method for bedside prognostication in COVID-19.
Background:
This study aimed to explore the predictors of disease severity in patients with coronavirus disease 2019 (COVID-19) using ambulatory electrocardiographic markers (AECG-Ms), which are prognostic predictors of cardiac death, as well as echocardiography and laboratory parameters.
Methods:
A prospective cohort study was conducted using data from 70 patients diagnosed with COVID-19 and admitted to the National Defense Medical College Hospital between January 2021 and December 2023. A high-resolution Holter electrocardiogram recorder was attached to all patients for 24 h within 48 h of admission, and AECG-Ms were measured. Laboratory tests and echocardiography were also performed.
Results:
Logistic univariate analysis revealed that the T-wave alternans (TWA) positivity rate was significantly higher in the fatal event group (all-cause mortality and onset of sustained ventricular tachycardia or ventricular fibrillation) than in the non-fatal event group. Kaplan-Meier curves at 30 days after admission showed a significant worsening in the survival rate of the TWA and late potential positive groups (log-rank test, p < 0.0001) compared with the other groups.
Conclusion:
In patients with COVID-19 without obvious cardiac disease, AECG-Ms were highly positive. The study findings may allow easy and rapid prediction of prognosis at the bedside of patients with COVID-19.
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