Tweet
J Clin Med
. 2022 Apr 30;11(9):2537.
doi: 10.3390/jcm11092537.
Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
Giulia Savelloni 1 , Maria Chiara Gatto 2 3 , Francesca Cancelli 1 , Anna Barbetti 1 , Francesco Cogliati Dezza 1 , Cristiana Franchi 1 , Martina Carnevalini 1 , Gioacchino Galardo 4 , Tommaso Bucci 4 , Maria Alessandroni 5 , Francesco Pugliese 6 , Claudio Maria Mastroianni 1 , Alessandra Oliva 1
Affiliations
- PMID: 35566664
- DOI: 10.3390/jcm11092537
Abstract
Background: Electrocardiogram (ECG) offers a valuable resource easily available in the emergency setting.
Objective: Aim of the study was to describe ECG alterations on emergency department (ED) presentation or that developed during hospitalization in SARS-CoV-2-infected patients and their association with 28-day mortality.
Methods: A retrospective, single-center study including hospitalized patients with SARS-CoV-2 was conducted. ECG was recorded on ED admission to determine: heart rhythm, rate, and cycle; atrio-ventricular and intra-ventricular conduction; right ventricular strain; and ventricular repolarization. A specialized cardiologist blinded for the outcomes performed all 12-lead ECG analyses and their interpretation.
Results: 190 patients were included, with a total of 24 deaths (12.6%). Age (p < 0.0001) and comorbidity burden were significantly higher in non-survivors (p < 0.0001). Atrial fibrillation (AF) was more frequent in non-survivors (p < 0.0001), alongside a longer QTc interval (p = 0.0002), a lower Tp-e/QTc ratio (p = 0.0003), and right ventricular strain (p = 0.013). Remdesivir administration was associated with bradycardia development (p = 0.0005) but no increase in mortality rates. In a Cox regression model, AF (aHR 3.02 (95% CI 1.03-8.81); p = 0.042), QTc interval above 451 ms (aHR 3.24 (95% CI 1.09-9.62); p = 0.033), and right ventricular strain (aHR 2.94 (95% CI 1.01-8.55); p = 0.047) were associated with higher 28-day mortality risk.
Conclusions: QTc interval > 451 ms, right ventricular strain, and AF are associated with higher mortality risk in SARS-CoV-2 hospitalized patients. ECG recording and its appropriate analysis offers a simple, quick, non-expensive, and validated approach in the emergency setting to guide COVID-19 patients' stratification.
Keywords: COVID-19; SARS-CoV-2; atrial fibrillation; electrocardiogram; electrocardiography; emergency department; heart rhythm disorders; right ventricular strain.