The prognostic significance of electrocardiography findings in patients with coronavirus disease 2019: A retrospective study

Abstract

Background Coronavirus disease 2019 (COVID‐19) has reached a pandemic level. Cardiac injury is not uncommon among COVID‐19 patients. We sought to describe the electrocardiographic characteristics and to identify the prognostic significance of electrocardiography (ECG) findings of patients with COVID‐19. Hypothesis ECG abnormality was associated with higher risk of death. Methods Consecutive patients with laboratory‐confirmed COVID‐19 and definite in‐hospital outcome were retrospectively included. Demographic characteristics and clinical data were extracted from medical record. Initial ECGs at admission or during hospitalization were reviewed. A point‐based scoring system of abnormal ECG findings was formed, in which 1 point each was assigned for the presence of axis deviation, arrhythmias, atrioventricular block, conduction tissue disease, QTc interval prolongation, pathological Q wave, ST‐segment change, and T‐wave change. The association between abnormal ECG scores and in‐hospital mortality was assessed in multivariable Cox regression models. Results A total of 306 patients (mean 62.84 ± 14.69 years old, 48.0% male) were included. T‐wave change (31.7%), QTc interval prolongation (30.1%), and arrhythmias (16.3%) were three most common found ECG abnormalities. 30 (9.80%) patients died during hospitalization. Abnormal ECG scores were significantly higher among non‐survivors (median 2 points vs 1 point, p < 0.001). The risk of in‐hospital death increased by a factor of 1.478 (HR 1.478, 95% CI 1.131–1.933, p = 0.004) after adjusted by age, comorbidities, cardiac injury and treatments. Conclusions ECG abnormality was common in patients admitted for COVID‐19 and was associated with adverse in‐hospital outcome. In‐hospital mortality risk increased with increasing abnormal ECG scores.

Electrocardiographic Changes in COVID-19 Patients: A Hospital-based Descriptive Study

“…In a retrospective study to highlight the prognostic significance of ECG in COVID, Yang et al have compared the ECG changes in survivors and nonsurvivors. 30 It was observed that the nonsurvivors had significantly higher rates of prolonged QTc interval, axis deviation, arrhythmias, ST-T changes, and an overall higher abnormal ECG score. In our study population, QTc prolongation and tachycardia were the commonest changes in the deceased.…”

Prognostic value of initial electrocardiography in predicting long-term all-cause mortality in COVID-19

“…In particular, the primary advantages of ECG in COVID-19 include its ease in use, nominal labor intensiveness, minimal COVID-19 exposure risk, and wide availability and accessibility throughout hospitals, emergency departments, and outpatient clinics. Its short-term prognostic utility in COVID-19 has previously been described [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ], further supporting its clinical application in this population. In light of an ongoing pandemic, we believe that the fundamental role of ECG extends beyond its diagnostic capacity to immediately detect time-sensitive conditions to include the powerful prediction of long-term mortality in patients with COVID-19.…”

“…Owing to its widespread availability, ease of use, and minimal cost, one such tool that has been applied for this purpose is electrocardiography (ECG). Several studies have utilized ECG to identify untoward prognostic markers in COVID-19, which include atrial fibrillation (AF)/flutter [ [11] , [12] , [13] , [14] , [15] ], right-heart strain [ 13 , 16 ], intraventricular conduction abnormalities [ 11 , 12 , [17] , [18] , [19] ], ST segment abnormalities [ [12] , [13] , [14] ], and ischemic T-wave inversions [ 11 , 17 ]. However, these investigations often included only hospitalized patients and failed to prognosticate beyond in-hospital or 30-day outcomes.…”

Characteristics of bradyarrhythmia in patients with COVID‐19: Systematic scoping review

“…Table 1 describes the main characteristics of the 11 observational studies from the scoping review 11–20 . Seven studies (Antwi‐Amoabeng et al., Chen et al., Han et al., Kunal et al., Ray‐Acha et al., Wang et al., and Yang et al.)…”

“…Table 1 describes the main characteristics of the 11 observational studies from the scoping review. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Seven studies (Antwi‐Amoabeng et al., Chen et al., Han et al., Kunal et al., Ray‐Acha et al., Wang et al., and Yang et al.) aimed to characterize electrocardiogram (EKG) findings among COVID‐19 patients without a particular focus on bradycardia.…”