Ventricular repolarization heterogeneity in patients with COVID‐19: Original data, systematic review, and meta‐analysis

Abstract

Background Coronavirus disease‐2019 (COVID‐19) has been associated with an increased risk of acute cardiac events. However, the effect of COVID‐19 on repolarization heterogeneity is not yet established. In this study, we evaluated electrocardiogram (ECG) markers of repolarization heterogeneity in patients hospitalized with COVID‐19. In addition, we performed a systematic review and meta‐analysis of the published studies. Methods QT dispersion (QTd), the interval between T wave peak to T wave end (TpTe), TpTe/QT (with and without correction), QRS width, and the index of cardio‐electrophysiological balance (iCEB) were calculated in 101 hospitalized COVID‐19 patients and it was compared with 101 non‐COVID‐19 matched controls. A systematic review was performed in four databases and meta‐analysis was conducted using Stata software. Results Tp‐Te, TpTe/QT, QRS width, and iCEB were significantly increased in COVID‐19 patients compared with controls (TpTe = 82.89 vs. 75.33 ms (ms), p‐value = .005; TpTe/QT = 0.217 vs. 0.203 ms, p‐value = .026). After a meta‐analysis of 679 COVID‐19 cases and 526 controls from 9 studies, TpTe interval, TpTe/QT, and TpTe/QTc ratios were significantly increased in COVID‐19 patients. Meta‐regression analysis moderated by age, gender, diabetes mellitus, hypertension, and smoking reduced the heterogeneity. QTd showed no significant correlation with COVID‐19. Conclusion COVID‐19 adversely influences the ECG markers of transmural heterogeneity of repolarization. Studies evaluating the predictive value of these ECG markers are warranted to determine their clinical utility.

Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device

“…Furthermore, there was a significant correlation between positive PCR result and TWA value, after adjustment of other confounding variables (R 2 = 0.081, P = 0.030). This finding is in agreement with earlier meta-analyses that have described the effect of COVID-19 on various ECG indicators of repolarization heterogeneity [5,15].…”

“…Repolarization parameters measured with a surface electrocardiogram (ECG) at admission may be able to predict 30-day and 1-year outcomes in COVID-19 patients, thus emphasizing their prognostic role [ 13 , 14 ]. Nevertheless, the optimal measurement and interpretation for manual ECG acquisition for some of these variables are still unknown and carry the risk of interobserver variability [ 15 ].…”

Prognostic value of index of cardiac electrophysiological balance among US middle-aged adults

“…One study showed that iCEB and iCEBc were elevated after hemodialysis (iCEB: 4.38 ± 0.76 vs. 4.02 ± 0.73, P = 0.016; iCEBc: 4.91 ± 0.73 vs. 4.42 ± 0.80, P = 0.006), but there was no significant change in the QT interval or QTc, indicating that the new ECG marker was more sensitive to cardiac electrophysiological balance ( 22 ). However, in some studies, differences in iCEB were often explained by differences in QTc or QRS duration ( 12 , 23 ). In fact, no study has directly linked iCEBc to cardiac or all-cause death.…”

Impact of COVID-19 on Cardiovascular Disease

“…ECG analysis of 101 COVID-19 patients revealed that COVID-19 might impair cardiac electric conduction. Mahmoudi and colleagues could demonstrate that markers of ventricular repolarization, namely, the T wave peak to the T wave end (Tp-Te), the QRS width, the index of cardio-electrophysiological balance (iCEB), as well as the ratio between TpTe and the QT interval, were increased in COVID-19 patients compared to matched controls [ 116 ]. Studies showing a clear correlation between COVID-19 and ventricular arrhythmias are still missing.…”