Key result
Treatment with hydroxychloroquine and azithromycin significantly increased the index of cardiac electrophysiological balance (iCEB) compared to hydroxychloroquine alone (4.06 vs 3.8, p=0.03) in patients with COVID-19.
Why the study?
The common cardiac toxicities of hydroxychloroquine and azithromycin were not well defined in patients with COVID-19.
Does the combination of hydroxychloroquine and azithromycin alter the index of cardiac electrophysiological balance (iCEB) compared to hydroxychloroquine alone in patients with COVID-19 pneumonia?
Cohort (n=164)
No
Does the combination of hydroxychloroquine and azithromycin alter the index of cardiac electrophysiological balance (iCEB) compared to hydroxychloroquine alone in patients with COVID-19 pneumonia?
Absolute Event Rate: 4.06% vs 3.8%
p-value: p=0.03
The combination of hydroxychloroquine and azithromycin significantly increases the index of cardiac electrophysiological balance (iCEB) and QTc compared to hydroxychloroquine alone, highlighting an elevated risk for drug-induced arrhythmias in COVID-19 patients.
Combination associated with higher iCEB; hypothesis-generating for arrhythmia risk in COVID-19, needing randomized confirmation.
Background/Aim: The common cardiac toxicities of hydroxychloroquine (HCQ) and azithromycin (AZ) are not well defined in COVID-19 patients. Index of cardiac electrophysiological balance (iCEB) is used as a novel risk marker for drug-induced arrhythmias. The purpose of this study was to evaluate ventricular repolarization using iCEB and other conventional ECG parameters such as the end of electrocardiographic T wave (Tp-e) interval, Tp-e/QT ratio, and Tp-e/ heart rate-corrected QT (QTc) ratio in COVID-19 patients treated with HCQ and AZ. Methods: This retrospective study enrolled 164 patients diagnosed with COVID-19 pneumonia in the Emergency Department (ED) and then transferred to the ward or the intensive care unit in April 2020. Results: A total of 164 patients with a mean age of 47 ( There were 38 and 126 patients in Groups HTQ and HTQ+AZ, respectively. On the 5 th day of hospitalization, all patients' heart rates were significantly lower (P<0.001), while QTc, QT max (V5-V6), QTmin, Tp-e (V5-V6), and iCEB values were significantly higher (P=0.01 and P<0.001 for the rest, respectively) compared to the basal values measured in the ED (P<0.001). iCEB values of the HTZ+AZ group were significantly higher than those of the HTQ group (P=0.03). iCEBc strongly positively correlated with Tp-e/QT (V5), and strongly negatively correlated with Tp-e (V5).
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Araç et al. (2021) conducted a cohort in COVID-19 pneumonia (n=164). Hydroxychloroquine and azithromycin vs. Hydroxychloroquine alone was evaluated on Index of cardiac electrophysiological balance (iCEB) on the 5th day of hospitalization (p=0.03). Treatment with hydroxychloroquine and azithromycin significantly increased the index of cardiac electrophysiological balance (iCEB) compared to hydroxychloroquine alone (4.06 vs 3.8, p=0.03) in patients with COVID-19.
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