The electrocardiographic manifestations and derangements of 2019 novel coronavirus disease (COVID-19)

Abstract

Electrocardiographic (ECG) findings in patients admitted with COVID-19 and a decision tree to predict their survival were assessed. 145 consecutive patients with severe COVID-19 infection were selected. Patient demographics, ECG variables, peak troponins, use of standard medications, and clinical outcomes were analyzed using descriptive and inferential statistics, and a predictive model of survival was developed using classification tree analysis. Of the 145 admitted patients, 38 (26%) died. Deceased patients were more likely to have a significantly higher incidence of poor R-Wave progression [6 of 37 (16.2%) Vs. 0 of 104 (0%), p < 0.001] as well as prolonged QTc values [24 of 37 (64.9%) Vs. 38 of 99 (38.4%), p 0.006]. Significant ST segment depressions were found in 5 of 37 (13.5%) of the deceased category compared to 0% in the non-deceased (p < 0.01). Right and/or left atrial enlargement was more prevalent in the deceased cohort [7 of 37 (18.9%) Vs. 4 of 104 (3.8%), p = 0.03]. Bundle branch blocks were more prevalent in the deceased group [9 of 35 (25.8%) Vs. 7 of 104 (6.7%), p 0.002]. Peak troponins were significantly higher in the deceased group (1.0 Vs 0.07 ng/ml, p < 0.001) A prediction tree built utilizing age, PACs, troponins and QTc had an accuracy of 85.5%. 65 of 74 patients (87.8%) were correctly predicted to survive, while 23 of 29 (79.3%) were correctly predicted to become deceased. Among patients hospitalized with Covid-19, the parameters of age, QT interval, troponin and PACs are useful for prognostication and help predict survival with reasonable accuracy.

ECG Prediction of Mortality in COVID-19 Patients by Sokolow-Lyon Voltage

“…In our study, there was a significant rise in mortality due to signs of cardiac involvement in COVID-19, which is consistent with some previous results. This risk was mainly observed by four times for myocardial infarction, 2.59 times for poor R progression, and of 1.6 times for atrioventricular block (15,16,(20)(21)(22). Besides, hypertrophy, either as an indicator of previously diseased heart or a heart facing an acute pressure overload, also increased the risk more than two times (17).…”

Clinical and electrocardiographic outcomes evaluated by telemedicine of outpatients with clinical suspicion of COVID-19 treated with chloroquine compounds in Brazil†

“…The new coronavirus also affects the cardiovascular system, especially in severe cases and in patients with established cardiovascular disease. Acute myocardial injury, the most frequent cardiac abnormality (8–20% of patients), is associated with a worse prognosis ( 4 – 6 ). Furthermore, there is an association of COVID-19 with acute coronary syndromes, venous thromboembolism, heart failure—as a consequence of a deterioration of underlying heart disease or induced by viral myocarditis—and a myriad of rhythm disturbances ( 7 ).…”