Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be associated with myocardial injury. Identification of at-risk patients and mechanisms underlying cardiac involvement in COVID-19 remains unclear. During hospitalization for COVID-19, high troponin level has been found to be an independent variable associated with in-hospital mortality and a greater risk of complications. Electrocardiographic (ECG) abnormalities could be a useful tool to identify patients at risk of poor prognostic. The aim of our study was to assess if specific ECGs patterns could be related with in-hospital mortality in COVID-19 patients presenting to the ED in a European country. Methods From February 1st to May 31st, 2020, we conducted a multicenter study in three hospitals in France. We included adult patients (≥ 18 years old) who visited the ED during the study period, with ECG performed at ED admission and diagnosed with COVID-19. Demographic, comorbidities, drug exposures, signs and symptoms presented, and outcome data were extracted from electronic medical records using a standardized data collection form. The relationship between ECG abnormalities and in-hospital mortality was assessed using univariate and multivariable logistic regression analyses. Results An ECG was performed on 275 patients who presented to the ED. Most of the ECGs were in normal sinus rhythm (87%), and 26 (10%) patients had atrial fibrillation/flutter on ECG at ED admission. Repolarization abnormalities represented the most common findings reported in the population (40%), with negative T waves representing 21% of all abnormalities. We found that abnormal axis (adjusted odds ratio: 3.9 [95% CI, 1.1–11.5], p = 0.02), and left bundle branch block (adjusted odds ratio: 7.1 [95% CI, 1.9–25.1], p = 0.002) were significantly associated with in-hospital mortality. Conclusions ECG performed at ED admission may be useful to predict death in COVID-19 patients. Our data suggest that the presence of abnormal axis and left bundle branch block on ECG indicated a higher risk of in-hospital mortality in COVID-19 patients who presented to the ED. We also confirmed that ST segment elevation was rare in COVID-19 patients.

Electrocardiogram abnormalities and prognosis in COVID-19

“…This may be due to the fact that in our institution, we prescribed HCQ/AZT combination regimen during a limited period (04/06/2020 to 04/16/2020) in a limited number of patients (n = 13) and ECG was not systematically performed. Other ECG abnormalities that we describe in our study are consistent with the literature ( 26 – 28 , 33 ). Interestingly, we found that left bundle branch block, S1Q3 pattern and repolarization abnormalities were independently associated with death in cases of COVID-19.…”

Electrocardiographic Pathological Findings Caused by the SARS-CoV-2 Virus Infection: Evidence from a Retrospective Multicenter International Cohort Longitudinal Pilot Study of 548 Subjects

“…A fair number of studies have deepened the prognostic role of ECG in COVID-19 patients, finding significant combinations of various parameters with increased mortality or critical illness: signs of previous myocardial infarction [ 16 ], acute change in the ST tract and T wave [ 16 , 17 ], left bundle branch block [ 18 ], intraventricular block [ 19 ], premature atrial beats [ 19 ], right bundle branch block [ 19 ], right ventricular strain [ 20 ], fragmented QRS [ 21 ], heart rate variability [ 22 ], poor R wave progression [ 23 ], and lengthening of QTc interval and subsequent development of life-threatening arrhythmias [ 3 ]. COVID-19 increases the risk of myocarditis, but it appears that direct myocardial involvement in SARS-CoV-2 infection is relatively rare [ 24 ] compared to extensive evidence of ECG alterations or increased heart damage enzymes.…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…Retrospective analyses have identified several ECG features that are related to a worse prognosis in COVID-19 (Fig. 4) [260][261][262][268][269][270][271][272][273]. Lowvoltage QRS complexes, previously shown to confer prognostic value in non-COVID-19 myocarditis [271], are also associated with increased mortality risk in COVID-19 patients [272].…”