Document Type : Original Article(s)


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.
METHOD: 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.


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