Document Type : Original Article
Authors
1 Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
2 Medical Center, Urmia University of Medical Sciences, Urmia, Iran
3 Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran
Abstract
BACKGROUND: Cardiac injury in COVID-19 patients confers a worse prognosis. The interpretation of electrocardiography can be beneficial in the early diagnosis of probable cardiac involvement. After adjusting for other variables, we sought to determine if the initial ECG on admission could add additional prognostic value.
METHODS: In this single-center cross-sectional study, 1165 patients with a positive COVID-19 PCR between Feb 2020 and Nov 2021 were enrolled in our study. Patients were grouped according to their admitted units, and survivors to hospital discharge or non-survivors. Predictors of ICU admission and in-hospital mortality were determined using univariate analysis and a logistic regression model.
RESULTS: The mean age was 55.6 ± 16.2 years and 52% were male. Out of 1165 patients, 149 deaths (12.8%) were recorded during hospitalization. Sinus tachycardia was the most common dysrhythmia, followed by premature atrial and ventricular beats, sinus bradycardia, and atrial fibrillation (28.6%, 5.6%, 3.9%, and 2.1%, respectively). Age (p<0.001), sex (p=0.006), history of diabetes mellitus (p=0.002), hypertension (p=0.018), ischemic heart disease (p=0.004), and cancer (p<0.001) were more frequent among non-survivors. Among ECG findings, tachycardia, low voltage QRS, ST-T changes, and dysrhythmia were related to an increased mortality risk. However, in regression analysis, only sex (OR 1.89, 95% CI 1.2 to 2.9, p=0.004), age (OR 1.03, 95% CI 1.02 to 1.05, p<0.001), and initial tachycardia (OR 1.02, 95% CI 1.01 to 1.03, p<0.001) were independent predictors of in-hospital mortality.
CONCLUSION: Our data suggest that initial electrocardiographic findings could be helpful in distinguishing patients with an increased risk for ICU admission or in-hospital death.
Keywords
2. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Jul 1;5(7):811-18. https://doi.org/10.1001/jamacardio.2020.1017
3. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020 Jul 1;5(7):802-10. https://doi.org/10.1001/jamacardio.2020.0950
4. He J, Wu B, Chen Y, Tang J, Liu Q, Zhou S, et al. Characteristic Electrocardiographic Manifestations in Patients With COVID-19. Can J Cardiol. 2020 Jun;36(6):966.e1-e4. https://doi.org/10.1016/j.cjca.2020.03.028
5. Long B, Brady WJ, Bridwell RE, Ramzy M, Montrief T, Singh M, et al. Electrocardiographic manifestations of COVID-19. Am J Emerg Med. 2021 Mar;41:96-103. https://doi.org/10.1016/j.ajem.2020.12.060
6. De Carvalho H, Leonard-Pons L, Segard J, Goffinet N, Javaudin F, Martinage A, et al. Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study. BMC Emerg Med. 2021 Nov 19;21(1):141. https://doi.org/10.1186/s12873-021-00539-8
7. Elias P, Poterucha TJ, Jain SS, Sayer G, Raikhelkar J, Fried J, et al. The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19. Mayo Clin Proc. 2020 Oct;95(10):2099-109. https://doi.org/10.1016/j.mayocp.2020.07.028
8. Pishgahi M, Yousefifard M, Safari S, Ghorbanpouryami F. Electrocardiographic Findings of COVID-19 Patients and Their Correlation with Outcome; a Prospective Cohort Study. Front Emerg Med 2020;5(2):e17. https://doi.org/10.18502/fem.v5i2.5608
9. Harbalıoğlu H, Genc O, Alıcı G, Quisi A, Yıldırım A. Features on ECG During Admission May Predict in-hospital Events for COVID-19 Patients. Konuralp Medical Journal 2021;13(S1):401-10.
https://doi.org/10.18521/ktd.922646
10. Savelloni G, Gatto MC, Cancelli F, Barbetti A, Cogliati Dezza F, Franchi C, et al. Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19. J Clin Med. 2022 Apr 30;11(9):2537. https://doi.org/10.3390/jcm11092537
11. Nikoo M H, Sadeghi A, Estedlal A, et al. ECG Prediction of Mortality in COVID-19 Patients by Sokolow-Lyon Voltage. Shiraz E-Med J 2022;23(11):e128688. https://doi.org/10.5812/semj-128688
12. Umeh CA, Kumar S, Wassel E, Barve P. Meta-analysis and systematic literature review of COVID-19 associated bradycardia as a predictor of mortality. Egypt Heart J. 2022 Jun 4;74(1):47. https://doi.org/10.1186/s43044-022-00284-8
13. Moreno-Torres V, Muñoz-Serrano A, Calderón-Parra J, Mills-Sánchez P, Pintos-Pascual I, Rodríguez-Olleros C, et al. Mortality by COVID-19 Before Vaccination - One Year Experience of Hospitalized Patients in Madrid. Int J Infect Dis. 2022 Mar;116:339-43. https://doi.org/10.1016/j.ijid.2022.01.043
14. Nasrollahzadeh Sabet M, Khanalipour M, Gholami M, Sarli A, Rahimi Khorrami A, Esmaeilzadeh E. Prevalence, Clinical Manifestation and Mortality Rate in COVID-19 Patients with Underlying Diseases. J Arak Uni Med Sci 2020;23(5):740-49. https://doi.org/10.32598/JAMS.23.COV.5797.1
15. Mazaherpour H, Soofian M, Farahani E, Saebbian A, Etebari M, Mazaherpour S, Ashrafian F, Ramezani A. Evaluating the Factors Affecting COVID-19 Patients’ Mortality in Arak in 2020. Can Respir J. 2022 Sep 16;2022:9594931. https://doi.org/10.1155/2022/9594931
16. Ikram AS, Pillay S. Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study. BMC Emerg Med. 2022 Apr 29;22(1):68. https://doi.org/10.1186/s12873-022-00631-7
17. Mahmud R, Gray A, Nabeebaccus A, Whyte MB. Incidence and outcomes of long QTc in acute medical admissions. Int J Clin Pract. 2018 Nov;72(11):e13250. https://doi.org/10.1111/ijcp.13250
18. Amitabh P, Priya G,Yogendra KA, Vinod S. ST-elevation myocardial infarction in patients with Covid-19 -- A case series. IHJ Cardiovascular Case Reports 2021;5(3):142-44. https://doi.org/10.1016/j.ihjccr.2021.10.005
19. Kaur P, Patel P, Singh B, Guragai N, Vasudev R, Virk HS, et al. ST-Segment Elevation in Patients with COVID-19: A Late Complication. Am J Med Sci. 2021 Mar;361(3):403-05. https://doi.org/10.1016/j.amjms.2020.09.019
20. Fardman A, Zahger D, Orvin K, Oren D, Kofman N, Mohsen J, et al. Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes-A multicenter registry. PLoS One. 2021 Jun 18;16(6):e0253524. https://doi.org/10.1371/journal.pone.0253524
21. Katsoularis I, Fonseca-Rodríguez O, Farrington P, Lindmark K, Fors Connolly AM. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study. Lancet. 2021 Aug 14;398(10300):599-607. https://doi.org/10.1016/S0140-6736(21)00896-5
22. Behnemoon M, Mohamadi A. Complete heart block: A case report and a review on this rare cardiac manifestation of Covid-19. ARYA Atherosclerosis Journal 2022;18(6):1-6. https://doi.org/10.48305/arya.2022.16329.2357
23. Amaratunga EA, Corwin DS, Moran L, Snyder R. Bradycardia in Patients With COVID-19: A Calm Before the Storm? Cureus. 2020 Jun 13;12(6):e8599. https://doi.org/10.7759/cureus.8599
24. Lampert J, Miller M, Halperin JL. Prognostic Value of Electrocardiographic QRS Diminution in Patients Hospitalized With COVID-19 or Influenza. Am J Cardiol 2021;159:129-37. https://doi.org/10.1016/j.amjcard.2021.07.048
25. Kaliyaperumal D, Bhargavi K, Ramaraju K, Nair KS, Ramalingam S, Alagesan M. Electrocardiographic Changes in COVID-19 Patients: A Hospital-based Descriptive Study. Indian J Crit Care Med 2022;26(1):43-8. https://doi.org/10.5005/jp-journals-10071-24045
26. Pinto-Filho MM, Paixão GM, Gomes PR, Soares CPM, Singh K, Rossi VA, et al. Electrocardiographic findings and prognostic values in patients hospitalised with COVID-19 in the World Heart Federation Global Study. Heart. 2023 Apr 12;109(9):668-73. -https://doi.org/10.1136/heartjnl-2022-321754
)