Prolonged corrected QT interval in hospitalized patients with coronavirus disease 2019 in Dubai, United Arab Emirates: a single-center, retrospective study

Abstract

Objective To evaluate the association of a prolonged corrected QT (QTc) interval in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its association with in-patient mortality. Methods A cohort of 745 patients were recruited from a single center between 1 March 2020 and 31 May 2020. We analyzed the factors associated with a prolonged QTc and mortality. Results A prolonged QTc interval >450 ms was found in 27% of patients admitted with SARS-CoV-2 infection. These patients were predominantly older, on a ventilator, and had hypertension, diabetes mellitus, or ischemic heart disease. They also had high troponin and D-dimer concentrations. A prolonged QTc interval had a significant association with the requirement of ventilator support and was associated with an increased odds of mortality. Patients who died were older than 55 years, and had high troponin, D-dimer, creatinine, procalcitonin, and ferritin concentrations, a high white blood cell count, and abnormal potassium concentrations (hypo- or hyperkalemia). Conclusions A prolonged QTc interval is common in patients with SARS-CoV-2 infection and it is associated with worse outcomes. Older individuals and those with comorbidities should have an electrocardiogram performed, which is noninvasive and easily available, on admission to hospital to identify high-risk patients.

Relationship between Prolonged QT Interval and Mortality in COVID-19 Patients at Ulin Hospital, Banjarmasin

“…QT prolongation (42.0%) in COVID-19 was found to be 4.48 times a significantly higher risk of death than normal QT interval. This finding was supported by a previous retrospective study in Dubai, which stated that a QTc interval >450 ms was significantly associated with ventilation requirements and increased mortality [15]. A study by Fishbein et al found that delayed cardiac repolarization as indicated by QTc > 500 ms was an independent predictor of mortality in COVID-19 patients (OR= 1.41; 95% CI= 1.05-1.90) [16].…”

“…The QT interval on the ECG is one of the indicators in the clinical evaluation of patients at high risk of experiencing ventricular arrhythmias and myocardial infarction, which is characterized by increased cardiac biomarkers of troponin and BNP [15]. QT prolongation (42.0%) in COVID-19 was found to be 4.48 times a significantly higher risk of death than normal QT interval.…”

QT Interval Prolongation Is a Novel Predictor of 1-Year Mortality in Patients With COVID-19 Infection

“…COVID-19 infection is also associated with myocardial injury, indicated by both elevated cardiac biomarkers [Troponin and brain natriuretic peptide (BNP)] ( 12 – 15 ) and echocardiographic abnormalities ( 16 ). Previous studies described the association of QTc prolongation to myocardial injury and to short term mortality ( 17 – 19 ), and in the largest cohort consisting of 7,098 hospitalized COVID-19 patient, Fishbein et al ( 20 ) reported that extremely prolonged QTc (>500 ms) was an independent predictor for in-hospital mortality. However, the association of prolonged QTc to long term mortality, had not yet been described.…”