Fragmented QRS on surface electrocardiography as a predictor of cardiac mortality in patients with SARS-CoV-2 infection

Abstract

Aims Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is mainly a respiratory system disease, recent studies reported that cardiac injury is associated with poor outcomes in this population. There are few studies which assessed standard electrocardiogram (ECG) as a prognostic tool during the course of SARS-CoV-2 infection. The aim of this study is to identify the relationship between of ECG parameters and prognosis of patients infected with SARS-CoV-2. Method and results A total of 114 consecutive patients with a confirmed diagnosis of SARS-CoV-2 infection between March 2020 and May 2020 were included in the study. Standard 12‑lead surface ECG was reviewed for presence of fragmented QRS (fQRS), abnormal Q wave, T wave inversion, and duration of QRS. fQRS was observed in 36.8% ( n = 42) of the patients who had SARS-CoV-2. Patient groups with and without fQRS did not differ in terms of age, gender, the presence of comorbid diseases and medical treatment. Hospitalization duration, intensive care unit(ICU) requirement, all-cause mortality, and cardiac mortality were found to be higher in patients with fQRS (all p values <0.05). There was a positive correlation between QRS duration and duration of hospital stay ( p < 0.001, r = 0.421). QRS duration was also found to be associated with intensive care need, all-cause mortality, and cardiac mortality. Conclusion Our data shows that QRS duration and the presence of fQRS on standard ECG can help to identify patients with worse clinical outcome admitted for SARS-CoV-2 infection.

Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study

“…In this study, similar to our results, hospitalization duration, ICU requirement, all-cause mortality, and cardiac mortality were found to be higher in patients with COVID-19 with f-QRS. However, this study revealed that there was a positive relationship between QRS duration and duration of hospital stay, need for ICU, and mortality, but there was no relationship between T inversion and mortality (39). In contrast, no relationship was found between QRS duration and mortality in our study.…”

“…Especially in patients with COVID-19, f-QRS may be a predictor of poor clinical outcomes. In a recently published paper, Yildirim et al (39) studied 114 patients with COVID-19. In this study, similar to our results, hospitalization duration, ICU requirement, all-cause mortality, and cardiac mortality were found to be higher in patients with COVID-19 with f-QRS.…”

Serial Assessment of Myocardial Injury Markers in Mechanically Ventilated Patients With SARS-CoV-2 (from the Prospective MaastrICCht Cohort)

“…Strikingly, we found fragmentation of the QRS in 79% of patients, whereas previously, fragmented QRS was identified in 36.8% of patients and was a predictor of cardiac mortality in patients with COVID-19. 27 …”

Repolarization abnormalities on admission predict 1-year outcome in COVID-19 patients

“…Many small studies have shown associations between ECG abnormalities and outcome. In a retrospective study including 114 patients with COVID-19, QRS duration and presence of fQRS were associated with all-cause and cardiac mortality [17] . Using the same criteria they reported fQRS in 36.8% of patients, whereas in our population fQRS was present in 20.2%.…”