Key result
COVID-19 is linked to QTc prolongation in ~48% of hospitalized patients without impacting mortality.
Why the study?
The specific effect of COVID-19 on QTc prolongation has not been studied well despite known cardiac involvement in SARS-CoV-2 infection.
Does long QTc increase mortality in adult patients with COVID-19?
Observational (n=130)
No
Does long QTc increase mortality in adult patients with COVID-19?
p-value: p=<0.001
Nearly half of adult patients with COVID-19 developed QTc prolongation, though this was not associated with a statistically significant increase in mortality.
Highlights potential direct myocardial injury in COVID-19; leaves open whether this informs targeted therapies without prospective data.
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme-2 receptors on host cells to enter the cells. These receptors are expressed on heart muscle tissue and the tissues of other major organs, which supports the primary accepted theory for the direct cardiac cell injury of coronavirus disease 2019 (COVID-19) and the associated cardiorespiratory manifestations. The SARS-CoV-2 infection leads to unstable myocardial cell membranes due to hypoxia, myocarditis, myocardial ischemia, and abnormal host immune response. This is the main reason behind arrhythmia and electrocardiogram (ECG) changes during COVID-19. However, the specific effect on QTc has not been studied well. Therefore, this study aimed to examine the association between COVID-19 and QTc changes. Methodology We conducted an observational, retrospective review of hospital medical records of 320 adult participants diagnosed with COVID-19 at our facility. After applying the exclusion criteria, 130 participants were included and distributed into two groups. One group had long QTc, and one group had normal QTc. Data were collected and recorded using Microsoft Excel. We used SPSS Statistics for Windows, Version 20.0. (IBM Corp., Armonk, NY, USA) to analyze the data. Student's t-tests were performed for independent groups. Quantitative data were summarized using mean and standard deviation. Statistical significance was taken as p < 0.05. Results A total of 63 (48.4%) participants met the criteria for long QTc, and 67 (51.5%) participants had normal QTc (p < 0.001). There was no statistically significant difference in mortality outcomes between long QTc and normal QTc (0.8% vs. 3.8%, respectively; p = 0.21). Conclusions This study aimed to examine the association between COVID-19 and QTc changes. Nearly half of the participants had an increased QTc with COVID-19, and QTc length was not associated with mortality outcomes. Our results indicate that COVID-19 is an independent risk factor for QTc prolongation on ECG. Identifying COVID-19 as an independent risk factor for QTc prolongation is a clinically significant finding, and physicians should consider this when treating cardiac patients and possible COVID-19-positive patients.
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Alsallamin et al. (2022) conducted an observational in COVID-19 (n=130). COVID-19 was evaluated on QTc prolongation (p=<0.001). COVID-19 infection was associated with QTc prolongation in 48.4% of hospitalized patients, though this increase in QTc length was not associated with significant differences in mortality.
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