Key result
Mechanical ventilation does not alter ECG signs of acute right ventricular pressure overload in COVID-19.
Why the study?
Electrocardiographic features of critically ill COVID-19 patients were not well described, limiting understanding of cardiac involvement mechanisms.
Cross-Sectional (n=431)
Yes
Absolute Event Rate: 36% vs 28%
p-value: p=0.10
Almost all critically ill COVID-19 patients have abnormal ECGs at admission, with a significant proportion showing signs of acute right ventricular pressure overload.
ECG abnormalities common in critical COVID-19; leaves open prognostic utility of admission ECG for risk stratification.
AIMS: Our aim was to describe the electrocardiographic features of critical COVID-19 patients. METHODS AND RESULTS: We carried out a multicentric, cross-sectional, retrospective analysis of 431 consecutive COVID-19 patients hospitalized between 10 March and 14 April 2020 who died or were treated with invasive mechanical ventilation. This project is registered on ClinicalTrials.gov (identifier: NCT04367129). Standard ECG was recorded at hospital admission. ECG was abnormal in 93% of the patients. Atrial fibrillation/flutter was detected in 22% of the patients. ECG signs suggesting acute right ventricular pressure overload (RVPO) were detected in 30% of the patients. In particular, 43 (10%) patients had the S1Q3T3 pattern, 38 (9%) had incomplete right bundle branch block (RBBB), and 49 (11%) had complete RBBB. ECG signs of acute RVPO were not statistically different between patients with (n = 104) or without (n=327) invasive mechanical ventilation during ECG recording (36% vs. 28%, P = 0.10). Non-specific repolarization abnormalities and low QRS voltage in peripheral leads were present in 176 (41%) and 23 (5%), respectively. In four patients showing ST-segment elevation, acute myocardial infarction was confirmed with coronary angiography. No ST-T abnormalities suggestive of acute myocarditis were detected. In the subgroup of 110 patients where high-sensitivity troponin I was available, ECG features were not statistically different when stratified for above or below the 5 times upper reference limit value. CONCLUSIONS: The ECG is abnormal in almost all critically ill COVID-19 patients and shows a large spectrum of abnormalities, with signs of acute RVPO in 30% of the patients. Rapid and simple identification of these cases with ECG at hospital admission can facilitate classification of the patients and provide pathophysiological insights.
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Bertini et al. (2020) conducted a cross-sectional in Critically ill COVID-19 (n=431). Invasive mechanical ventilation vs. No invasive mechanical ventilation was evaluated on ECG signs of acute right ventricular pressure overload (RVPO) (p=0.10). Invasive mechanical ventilation during ECG recording did not significantly alter the prevalence of acute right ventricular pressure overload signs in critical COVID-19 patients (36% vs 28%, P=0.10).
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