Key result
An abnormal ECG at 7 days of hospitalization independently predicted major adverse events (mortality or mechanical ventilation) in COVID-19 patients (HR 3.2; 95% CI 1.2-8.7; p=0.02).
Why the study?
With growing evidence of cardiac injury in COVID-19, this study aimed to assess the prognostic value of serial electrocardiograms in COVID-19 patients.
Do abnormal ECG changes at 7 days predict major adverse events in hospitalized COVID-19 patients?
Cohort (n=269)
No
Do abnormal ECG changes at 7 days predict major adverse events in hospitalized COVID-19 patients?
Hazard Ratio: 3.2 (95% CI 1.2–8.7)
p-value: p=0.02
Serial ECG monitoring in hospitalized COVID-19 patients is valuable for risk stratification, as abnormal findings at 7 days independently predict mortality or need for mechanical ventilation.
Abnormal 7-day ECGs signal higher MAE risk; hypothesis-generating for serial monitoring, prospective validation needed before practice change.
BACKGROUND: There is growing evidence of cardiac injury in COVID-19. Our purpose was to assess the prognostic value of serial electrocardiograms in COVID-19 patients. METHODS: We evaluated 269 consecutive patients admitted to our center with confirmed SARS-CoV-2 infection. ECGs available at admission and after 1 week from hospitalization were assessed. We evaluated the correlation between ECGs findings and major adverse events (MAE) as the composite of intra-hospital all-cause mortality or need for invasive mechanical ventilation. Abnormal ECGs were defined if primary ST-T segment alterations, left ventricular hypertrophy, tachy or bradyarrhythmias and any new AV, bundle blocks or significant morphology alterations (e.g., new Q pathological waves) were present. RESULTS: Abnormal ECG at admission (106/216) and elevated baseline troponin values were more common in patients who developed MAE (p = .04 and p = .02, respectively). Concerning ECGs recorded after 7 days (159), abnormal findings were reported in 53.5% of patients and they were more frequent in those with MAE (p = .001). Among abnormal ECGs, ischemic alterations and left ventricular hypertrophy were significantly associated with a higher MAE rate. The multivariable analysis showed that the presence of abnormal ECG at 7 days of hospitalization was an independent predictor of MAE (HR 3.2; 95% CI 1.2-8.7; p = .02). Furthermore, patients with abnormal ECG at 7 days more often required transfer to the intensive care unit (p = .01) or renal replacement therapy (p = .04). CONCLUSIONS: Patients with COVID-19 should receive ECG at admission but also during their hospital stay. Indeed, electrocardiographic alterations during hospitalization are associated with MAE and infection severity.
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Bergamaschi et al. (2021) conducted a cohort in COVID-19 (n=269). Abnormal ECG at 7 days of hospitalization vs. Normal ECG at 7 days was evaluated on Major adverse events (MAE) composite of intra-hospital all-cause mortality or need for invasive mechanical ventilation (HR 3.2, 95% CI 1.2-8.7, p=0.02). An abnormal ECG at 7 days of hospitalization independently predicted major adverse events (mortality or mechanical ventilation) in COVID-19 patients (HR 3.2; 95% CI 1.2-8.7; p=0.02).
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