tetano
Editor, Senior Moderator
J Electrocardiol
. 2022 Oct 12;75:1-9.
doi: 10.1016/j.jelectrocard.2022.10.003. Online ahead of print.
Prognostic value of initial electrocardiography in predicting long-term all-cause mortality in COVID-19
Nicholas Kassis[SUP] 1 [/SUP], Ashish Kumar[SUP] 2 [/SUP], Shravani Gangidi[SUP] 1 [/SUP], Alex Milinovich[SUP] 3 [/SUP], Ankur Kalra[SUP] 4 [/SUP], Ajay Bhargava[SUP] 5 [/SUP], Venu Menon[SUP] 5 [/SUP], Oussama M Wazni[SUP] 5 [/SUP], John Rickard[SUP] 5 [/SUP], Umesh N Khot[SUP] 6 [/SUP]
Affiliations
Abstract
Background: The electrocardiography (ECG) has short-term prognostic value in coronavirus disease 2019 (COVID-19), yet its ability to predict long-term mortality is unknown. This study aimed to elucidate the predictive role of initial ECG on long-term all-cause mortality in patients diagnosed with COVID-19.
Methods: In this prospective cohort study, adults with COVID-19 who underwent ECG testing within a 17-hospital health system in Northeast Ohio and Florida between 03/2020-06/2020 were identified. An expert ECG reader analyzed all studies blinded to patient status. The associations of ECG characteristics with long-term all-cause mortality and intensive care unit (ICU) admission were assessed using Cox proportional hazards regression model and multivariable logistic regression models, respectively. Status of long-term mortality was adjudicated on 01/07/2022.
Results: Of 837 patients (median age 65 years, 51% female, 44% Black), 683 (81.6%) were hospitalized, 281 (33.6%) required ICU admission, 67 (8.0%) died in-hospital, and 206 (24.6%) died at final follow-up after a median (IQR) of 21 (9-103) days after ECG. Overall, 179 (20.7%) patients presented with sinus tachycardia, 12 (1.4%) with atrial flutter, and 45 (5.4%) with atrial fibrillation (AF). After multivariable adjustment, sinus tachycardia (E-value for HR=3.09, lower CI=2.2) and AF (E-value for HR=3.13, lower CI=2.03) each independently predicted all-cause mortality. At final follow-up, patients with AF had 64.5% probability of death compared with 20.5% for those with normal sinus rhythm (P<.0001).
Conclusions: Sinus tachycardia and AF on initial ECG strongly predict long-term all-cause mortality in COVID-19. The ECG can serve as a powerful long-term prognostic tool in COVID-19.
Keywords: COVID-19; ECG; atrial fibrillation; coronavirus disease 2019; electrocardiography.
. 2022 Oct 12;75:1-9.
doi: 10.1016/j.jelectrocard.2022.10.003. Online ahead of print.
Prognostic value of initial electrocardiography in predicting long-term all-cause mortality in COVID-19
Nicholas Kassis[SUP] 1 [/SUP], Ashish Kumar[SUP] 2 [/SUP], Shravani Gangidi[SUP] 1 [/SUP], Alex Milinovich[SUP] 3 [/SUP], Ankur Kalra[SUP] 4 [/SUP], Ajay Bhargava[SUP] 5 [/SUP], Venu Menon[SUP] 5 [/SUP], Oussama M Wazni[SUP] 5 [/SUP], John Rickard[SUP] 5 [/SUP], Umesh N Khot[SUP] 6 [/SUP]
Affiliations
- PMID: 36272350
- DOI: 10.1016/j.jelectrocard.2022.10.003
Abstract
Background: The electrocardiography (ECG) has short-term prognostic value in coronavirus disease 2019 (COVID-19), yet its ability to predict long-term mortality is unknown. This study aimed to elucidate the predictive role of initial ECG on long-term all-cause mortality in patients diagnosed with COVID-19.
Methods: In this prospective cohort study, adults with COVID-19 who underwent ECG testing within a 17-hospital health system in Northeast Ohio and Florida between 03/2020-06/2020 were identified. An expert ECG reader analyzed all studies blinded to patient status. The associations of ECG characteristics with long-term all-cause mortality and intensive care unit (ICU) admission were assessed using Cox proportional hazards regression model and multivariable logistic regression models, respectively. Status of long-term mortality was adjudicated on 01/07/2022.
Results: Of 837 patients (median age 65 years, 51% female, 44% Black), 683 (81.6%) were hospitalized, 281 (33.6%) required ICU admission, 67 (8.0%) died in-hospital, and 206 (24.6%) died at final follow-up after a median (IQR) of 21 (9-103) days after ECG. Overall, 179 (20.7%) patients presented with sinus tachycardia, 12 (1.4%) with atrial flutter, and 45 (5.4%) with atrial fibrillation (AF). After multivariable adjustment, sinus tachycardia (E-value for HR=3.09, lower CI=2.2) and AF (E-value for HR=3.13, lower CI=2.03) each independently predicted all-cause mortality. At final follow-up, patients with AF had 64.5% probability of death compared with 20.5% for those with normal sinus rhythm (P<.0001).
Conclusions: Sinus tachycardia and AF on initial ECG strongly predict long-term all-cause mortality in COVID-19. The ECG can serve as a powerful long-term prognostic tool in COVID-19.
Keywords: COVID-19; ECG; atrial fibrillation; coronavirus disease 2019; electrocardiography.