The effect of the severity COVID-19 infection on electrocardiography

Abstract

Objective Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of 7–28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). Methods A total of 219 patients that were hospitalized due to COVID-19 between April 15 and May 5, 2020 were enrolled in this study. Patients were divided into two groups according to the severity of COVID-19 infection: severe ( n = 95) and non-severe ( n = 124). ECG findings at the time of admission were recorded for each patient. Clinical characteristics and laboratory findings were retrieved from electronic medical records. Results Mean age was 65.2 ± 13.8 years in the severe group and was 57.9 ± 16.0 years in the non-severe group. ST depression (28% vs. 14%), T-wave inversion (29% vs. 16%), ST-T changes (36% vs. 21%), and the presence of fragmented QRS (fQRS) (17% vs. 7%) were more frequent in the severe group compared to the non-severe group. Multivariate analysis revealed that hypertension (odds ratio [OR]: 2.42, 95% confidence interval [CI]:1.03–5.67; p = 0.041), the severity of COVID-19 infection (OR: 1.87, 95% CI: 1.09–2.65; p = 0.026), presence of cardiac injury (OR: 3.32, 95% CI: 1.45–7.60; p = 0.004), and d-dimer (OR: 3.60, 95% CI: 1.29–10.06; p = 0.014) were independent predictors of ST-T changes on ECG. Conclusion ST depression, T-wave inversion, ST-T changes, and the presence of fQRS on admission ECG are closely associated with the severity of COVID-19 infection.

ECG with Prior Myocardial Infarction Pattern or acute ST-T Pathology is Associated with Death in Critically Ill COVID-19 Patients

“…Similar to our study, a cohort study of 756 patients with COVID-19 found that prior MI pattern, unspeci c repolarization abnormalities and T-wave inversion at hospital admission were associated with death while sinus tachycardia was not [21]. Further, patients with ST-T pathology at hospital admission have a higher risk of developing more severe disease [22]. In one study of 850 patients with ECG recorded at presentation to the emergency department, and another study of 269 patients that analysed ECG at hospital admission and the seventh day of hospitalization found that ST-T-pathology were predictive of death and invasive ventilation [23,33].…”

“…The electrocardiogram (ECG) is a readily available, non-invasive, radiation free diagnostic mainstay of cardiac pathology [15] used at some point in nearly all severely ill patients [16]. ECG abnormalities in patients with COVID-19 have been described in small case series early during the pandemic [17][18][19][20] and analyses of larger cohorts have found that ECG pathology at hospital admission was associated with more severe disease and higher mortality [9,[21][22][23][24]. Unfortunately, previous studies have not speci cally investigated patients admitted to the intensive care unit (ICU), who have the highest mortality [5].…”

Electrocardiographic findings in COVID-19 patients

“…32 In our study, mean QTc was higher among patients with severe disease and showed significance difference among severe and non-severe patient groups (p=0.005). No such difference was observed in a study by Ali et al 33 The relationship between ST-T changes on ECG and myocardial damage with poor prognosis has been demonstrated. 34 Abnormal ST segment deviation (elevation/depression) and T inversion together, were the most common (27.7%) abnormal ECG manifestation in our study.…”

Electrocardiographic findings in non-critical patients with coronavirus disease-2019

“…In another study, most patients had ECG pathology, including atrial fibrillation / flutter (5.6%), AV block (2.6%), premature atrial contractions (7.7%), premature ventricular contractions (3.4%), left-axis deviation (13.8%), right-axis deviation (5.5%), right-bundle branch block (7.8%), left-bundle branch block (1.5%), left ventricular hypertrophy (15.5%), right ventricular hypertrophy (4%), pathological Q wave (13.9%), localized ST elevation (0.7%), and localized T wave inversion (10.5%) [12]. In a study conducted in our country, tachycardia was found in 31%, ST segment pathology in 28%, T negativity in 22%, ST depression in 20%, and long QT in 5% of the patients [13]. In yet another study, ST-T abnormalities were reported in 30% and left ventricular hypertrophy, in 33% of the patients [14].…”

“…Deng Q et al reported that myocarditis, segmental wall motion abnormality on ECG, pulmonary hypertension, and pericardial effusion were more common and the mean ejection fraction was lower in patients with severe disease; however, tachycardia and ST segment pathologies were not different between patients with and without severe disease [15]. McCullugh et al reported that many pathological ECG findings were more common in nonsurviving patients, and in a study conducted in Turkey, ST segment pathologies, ST depression, and T negativity were reported more commonly in patients with severe disease [12,13]. In a COVID-19 case series of 18 patients with ST elevation, this ECG pathology occurred at the time of admission in 10 patients, and the outcome was mortality in 13 patients [16].…”