Coronavirus disease 2019 (COVID-19) and QTc prolongation

Abstract

Introduction The cause-and-effect relationship of QTc prolongation in Coronavirus disease 2019 (COVID-19) patients has not been studied well. Objective We attempt to better understand the relationship of QTc prolongation in COVID-19 patients in this study. Methods This is a retrospective, hospital-based, observational study. All patients with normal baseline QTc interval who were hospitalized with the diagnosis of COVID-19 infection at two hospitals in Ohio, USA were included in this study. Results Sixty-nine patients had QTc prolongation, and 210 patients continued to have normal QTc during hospitalization. The baseline QTc intervals were comparable in the two groups. Patients with QTc prolongation were older (mean age 67 vs. 60, P 0.003), more likely to have underlying cardiovascular disease (48% versus 26%, P 0.001), ischemic heart disease (29% versus 17%, P 0.026), congestive heart failure with preserved ejection fraction (16% versus 8%, P 0.042), chronic kidney disease (23% versus 10%, P 0.005), and end-stage renal disease (12% versus 1%, P < 0.001). Patients with QTc prolongation were more likely to have received hydroxychloroquine (75% versus 59%, P 0.018), azithromycin (18% vs. 14%, P 0.034), a combination of hydroxychloroquine and azithromycin (29% vs 7%, P < 0.001), more than 1 QT prolonging agents (59% vs. 32%, P < 0.001). Patients who were on angiotensin-converting enzyme inhibitors (ACEi) were less likely to develop QTc prolongation (11% versus 26%, P 0.014). QTc prolongation was not associated with increased ventricular arrhythmias or mortality. Conclusion Older age, ESRD, underlying cardiovascular disease, potential virus mediated cardiac injury, and drugs like hydroxychloroquine/azithromycin, contribute to QTc prolongation in COVID-19 patients. The role of ACEi in preventing QTc prolongation in COVID-19 patients needs to be studied further.

ECG pathology and its association with death in critically ill COVID-19 patients, a cohort study

“…after falling ill with COVID-19 compared to before [41]. Previously reported QT intervals ranges from a mean of 443-450 ms [40][41][42][43], which is somewhat longer than the mean of 440 ms reported in this study.…”

“…In their cohort, patients were older (74 vs 61 years) and had higher over-all mortality (46% vs 28%) compared to our study, which may account for some of the differences between our study and theirs. Previous studies reported longer QT interval in patients with COVID-19 compared to patients without COVID-19 [ 40 ] and QT prolongation after falling ill with COVID-19 compared to before [ 41 ]. Previously reported QT intervals ranges from a mean of 443–450 ms [ 40 – 43 ], which is somewhat longer than the mean of 440 ms reported in this study.…”

“…Previously reported QT intervals ranges from a mean of 443–450 ms [ 40 – 43 ], which is somewhat longer than the mean of 440 ms reported in this study. This difference may at least in part be explained by that the present study includes younger patients and fewer patients with previous heart disease, both of which are risk factors for QT prolongation [ 40 , 41 , 44 ].…”

The role of ECG as a mortality predictor in COVID-19 patients treated in the intensive care unit

“…With prolonged QTc, the frequency of ventricular arrhythmias and mortality rate increases especially in cardiovascular diseases. Prolonged QTc duration has been reported to be associated with prognosis in COVID-19 infection (14,15). In our study, the QTc duration was found to be significantly longer in the "deceased patient" group.…”

QTc Dispersion Predicts Prognosis in COVID-19 Disease

“…It has been reported that QTc of >455 ms in males and >465 ms in females are predictors of mortality, 8) and the absence of QT prolongation was associated with a good prognosis. 9) In contrast, Changal et al 10) reported that QTc prolongation was not associated with increased ventricular arrhythmias or mortality in multivariate analysis. Because QT prolongation is in part a result of myocardial damage, it cannot be discriminated independently.…”