T-wave inversion as a manifestation of COVID-19 infection: a case series

Abstract

Purpose Cardiac involvement with COVID-19 infection has become evident by elevated troponin, cardiac arrhythmias, ST segment elevation, myocarditis, fulminant heart failure, and sudden cardiac death. We aimed to describe the association of COVID-19 and T-wave inversion (TWI) in a large case series. Methods We conducted an observational, retrospective study of confirmed COVID-19 cases with at least one electrocardiogram (ECG) in a large hospital in New York City (March 23, 2020–April 23, 2020). Patients with new TWI or pseudonormalization were further analyzed. Mortality and the need for invasive mechanical ventilation were the main outcomes. Results A total of 3225 patients were screened; 195 (6%) were selected for further analysis: 181 with TWI and 14 with T-wave pseudonormalization. Mean age was 66 ± 7 years; 51% were male. TWI were more commonly noted in the lateral (71%), followed by anterior (64%), inferior (57%), and septal (26%) leads. A total of 44 patients (23%) had elevated troponin. A total of 50 patients died (26%). Mortality rates of 35%, and 52% were observed in patients with diffuse TWI, and elevated troponin, respectively. Mortality rate of 80% was observed in patients with both elevated troponin and diffuse TWI. Additionally, 30% of the entire cohort and 58% of patients with elevated troponin required invasive mechanical ventilation. Conclusion Our study demonstrates that new TWI is a relatively common finding in COVID-19 patients. Importantly, our findings suggest that new TWI or T-wave pseudonormalization, particularly with elevated troponin, was associated with higher rates of mechanical ventilation and in-hospital mortality. Supplementary Information The online version of this article (10.1007/s10840-020-00896-7) contains supplementary material, which is available to authorized users.

Prolonged QT predicts prognosis in COVID‐19

“…The multivariate analysis revealed that prolonged QTc on presentation was independently associated with an increased risk of mortality in COVID‐19 ( p = 0.001). This finding has rarely been reported and could easily have been overlooked 3,14 . Romero et al demonstrated that new T‐wave inversion in COVID‐19 was associated with mortality 14 .…”

“…This finding has rarely been reported and could easily have been overlooked. 3,14 Romero et al demonstrated that new T-wave inversion in COVID-19 was associated with mortality. 14 The ECGs reproduced in their manuscript to illustrate this T-wave inversion also demonstrate marked prolongation of the QTc, although this finding was not remarked upon and the interval was apparently not measured.…”

“…3,14 Romero et al demonstrated that new T-wave inversion in COVID-19 was associated with mortality. 14 The ECGs reproduced in their manuscript to illustrate this T-wave inversion also demonstrate marked prolongation of the QTc, although this finding was not remarked upon and the interval was apparently not measured. Lanza et al did find a prolonged QT in a small proportion (5.8%) of COVID-19 patients.…”

Electrocardiographic Risk Stratification in COVID-19 Patients

“…Though troponin elevation above the 99th percentile of the upper reference limit is considered the central marker of “myocardial injury,” mild elevation between 0.05 and 1 is often non-specific and associated with non-vascular etiologies such as strain, myocyte necrosis and increased cell membrane permeability ( 11 – 13 ). Indeed, mild Troponin elevation was a frequent finding in our cohort, present in 31% of patients with COVID-19.…”

“…Consistent with our findings, a recent study had demonstrated that T wave inversion is highly frequent finding in patients with COVID-19, conferring increased risk for mortality and particularly when accompanied by Troponin elevation (10). Though troponin elevation above the 99th percentile of the upper reference limit is considered the central marker of "myocardial injury, " mild elevation between 0.05 and 1 is often non-specific and associated with non-vascular etiologies such as strain, myocyte necrosis and increased cell membrane permeability (11)(12)(13). Indeed, mild Troponin elevation was a frequent finding in our cohort, present in 31% of patients with COVID-19.…”