Document Type : Original Article


1 Associate Professor of Cardiology, Fellowship of Echocardiography, Vascular and endovascular surgery research center, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate Professor, Clinical Research Development Unit, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Resident of cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


BACKGROUND: Coronavirus disease 2019 (COVID-19) may lead to myocardial damage and arrhythmia. Patients with ECG changes have shown an increased risk of mortality.
OBJECTIVE: We aimed to study the changes in the electrocardiogram, which may be of great significance for risk stratification of COVID-19-positive patients.
METHODS: A retrospective study was conducted to compare electrocardiogram changes and disease severity markers in COVID-19-positive patients admitted to a referral hospital between February 20 and March 20, 2020.
RESULTS: Our study consisted of 201 cases, including 123 males and 78 females. Ages ranged between 16 and 97 years old. Fifty-two (25.9%) cases had a history of ICU admission. Multivariate logistic regression analysis showed that a low O2 saturation level (OR = 0.920, 95% CI 0.868–0.976, p=0.005), several lab tests, ECG changes (OR = 46.84, 95% CI 3.876– 566.287, p = .002) and Age (OR = 1.03, 95% CI 1.000– 1.065, p = .048) were the independent risk factors for predicting mortality rate. In addition, we utilized multivariate logistic regression analysis, demonstrating that LBBB (OR = 4.601, 95%
CI: 1.357–15.600, p=0.014) is the only ECG risk factor associated with morbidity in elderly patients with ECG changes.
CONCLUSIONS: ECG changes are strong indicators of high mortality rates in elderly COVID-19 patients. ECG interpretations should therefore be used for risk stratification and predicting the need for ICU admission.