Electrocardiographic findings and prognostic values in patients hospitalised with COVID-19 in the World Heart Federation Global Study

Abstract

BackgroundCOVID-19 affects the cardiovascular system and ECG abnormalities may be associated with worse prognosis. We evaluated the prognostic value of ECG abnormalities in individuals with COVID-19.MethodsMulticentre cohort study with adults hospitalised with COVID-19 from 40 hospitals across 23 countries. Patients were followed-up from admission until 30 days. ECG were obtained at each participating site and coded according to the Minnesota coding criteria. The primary outcome was defined as death from any cause. Secondary outcomes were admission to the intensive care unit (ICU) and major adverse cardiovascular events (MACE). Multiple logistic regression was used to evaluate the association of ECG abnormalities with the outcomes.ResultsAmong 5313 participants, 2451 had at least one ECG and were included in this analysis. The mean age (SD) was 58.0 (16.1) years, 60.7% were male and 61.1% from lower-income to middle-income countries. The prevalence of major ECG abnormalities was 21.3% (n=521), 447 (18.2%) patients died, 196 (8.0%) had MACE and 1115 (45.5%) were admitted to an ICU. After adjustment, the presence of any major ECG abnormality was associated with a higher risk of death (OR 1.39; 95% CI 1.09 to 1.78) and cardiovascular events (OR 1.81; 95% CI 1.30 to 2.51). Sinus tachycardia (>120 bpm) with an increased risk of death (OR 3.86; 95% CI 1.97 to 7.48), MACE (OR 2.68; 95% CI 1.10 to 5.85) and ICU admission OR 1.99; 95% CI 1.03 to 4.00). Atrial fibrillation, bundle branch block, ischaemic abnormalities and prolonged QT interval did not relate to the outcomes.ConclusionMajor ECG abnormalities and a heart rate >120 bpm were prognostic markers in adults hospitalised with COVID-19.

Changes in dynamic electrocardiogram after COVID-19 infection: a self-controlled study

“…It is speculated that the possible reasons are direct myocardial injury caused by viral damage and cytokine storm, indirect endothelial injury, disruption of the renal angiotensin system, and pressure induced arrhythmia The activation of the sympathetic nervous system and the weakening of the vagus nerve's impact on the heart caused by the virus itself and in ammatory cytokine response lead to severe autonomic nervous system imbalance. After adjusting for multiple factors, sinus tachycardia (>120 bpm) was found to be an independent risk factor for in-hospital mortality, cardiovascular events, and ICU occupancy rate [17]. These studies also obtain the heart rate increase after COVID-19 infection through cross-sectional study or setting up a control group, which is consistent with our study.…”

Using Mendelian randomization to unveil the truth: does COVID-19 impact QT interval prolongation?

“…Numerous observational studies and case reports have suggested a potential link between COVID-19 and the prolongation of the QT interval on ECG 4,8,[13][14][15][20][21][22]35,36 . To address the limitations of confounding factors and reverse causality inherent in observational research 27 , we conducted an MR analysis to investigate whether COVID-19 has a genetic causal impact on QT interval changes.…”

“…ECG serves as an essential tool in managing COVID-19 patients, unveiling cardiac involvement such as atrial brillation, prolonged QT intervals, and ventricular and supraventricular arrhythmias 19 . Observational studies have indicated an independent association between QT interval prolongation and COVID-19, suggesting that QT interval prolongation may serve as an early prognostic marker for disease progression and mortality 4,8,[13][14][15][20][21][22] .…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…Moreover, lower heart rate variability on ECG, as a marker of vagal nerve activation, has also been linked to a greater risk of ITU admission and inpatient mortality [274]. A recent large multi‐centre cohort study showed that major ECG abnormalities and sinus tachycardia (>120 beats per minute) were linked to adverse clinical outcomes in COVID‐19 patients [275]. However, certain ECG findings, such as AF, bundle branch block, ischaemic abnormalities and prolonged QTc, were not associated with adverse clinical outcomes in this study [275], which appear to cast doubts over previous data suggesting their prognostic importance [240–242, 260–262, 268–273].…”

“…A recent large multi‐centre cohort study showed that major ECG abnormalities and sinus tachycardia (>120 beats per minute) were linked to adverse clinical outcomes in COVID‐19 patients [275]. However, certain ECG findings, such as AF, bundle branch block, ischaemic abnormalities and prolonged QTc, were not associated with adverse clinical outcomes in this study [275], which appear to cast doubts over previous data suggesting their prognostic importance [240–242, 260–262, 268–273]. The exact mechanisms underlying these differences in observation remain unclear and deserve further investigation.…”