Electrocardiographic Pathological Findings Caused by the SARS-CoV-2 Virus Infection: Evidence from a Retrospective Multicenter International Cohort Longitudinal Pilot Study of 548 Subjects

Abstract

COVID-19 has threatened the capability of receiving and allocating patients in emergency departments (EDs) all over the world. This is a retrospective cohort study to explore the role of a simple procedure like an ECG to screen for the severity of COVID-19 on admission to the ED. For this study, 548 consecutive patients were enrolled in a multicenter international registry and stratified upon ECG on admission with a simple distinction between normal vs. abnormal rhythm. Among patients in the abnormal ECG group were those with heart rates higher than 100 beats per minute and/or atrial fibrillation. Survival in patients with normal ECG rhythm was deemed below 75% after 58 days and then stabilized, while survival in patients with abnormal ECG rhythm was deemed below 75% after 11 days and below 50% after 21 days. A multivariate analysis including abnormal rhythm, gender, age, diabetes, obesity, respiratory failure during hospitalization, heart failure during hospitalization, and abnormal rhythm was an independent predictor of death (HR 7.20 95% CI 3.63–14.28, p < 0.01). This finding, if confirmed in large prospective studies, is promising for identifying a cheap and simple procedure for patients in need of a closer look.

The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients

“…It has been reported in previous studies that mortality is increased in patients with pathological findings seen on ECG. 14,15 In a study by Yuan et al, any ECG abnormality was an independent predictor of death. 16 A study that described ECG findings at hospitalization,+ in 431 patients who later died or underwent invasive ventilation reported abnormal ECG in 93% of patients.…”

Determinants of COVID-19 Disease Severity–Lessons from Primary and Secondary Immune Disorders including Cancer

“…The underlying pathobiology was unclear. Ancillary to these examples, two patients with antibody deficiency had cardiomyopathy or lymphoma, and two subjects experienced sepsis, renal failure and heart failure as the ultimate cause of death [101], as published recently [102][103][104]. Moreover, two patients with antibody deficiency, lung disease and heart disease as comorbid conditions died because of sepsis and renal failure, respectively.…”