The role of ECG as a mortality predictor in COVID-19 patients treated in the intensive care unit

Yıl 2021, Cilt: 4 Sayı: 6, 892 - 896, 24.09.2021

Semih Aydemir , Ekrem Şahan

https://doi.org/10.32322/jhsm.980551

Öz

Background: COVID-19 infection has reached serious morbidity and mortality rates all over the world for a short time. Many studies have investigated the relationship of COVID-19 disease with mortality and morbidity. In this study, we wanted to elucidate the relationship between rhythm character (sinus rhythm vs atrial fibrillation) and QTc and frontal plane QRS-T angle, which parameters are reflecting the depolarization-repolarization kinetics, and mortality, which were not emphasized enough in previous studies.
Material and Method: 259 patients admitted to the intensive care unit due to COVID-19 infection between 01.04.2020 and 01.12.2020 was included in the study. The demographic characteristics of the patients, clinical backgrounds, laboratory values ​​at the time of admission to the intensive care unit, and 12 derivation ECG records were obtained from the patient files. Rhythm, PR distance, QRS duration and morphology, QT interval, T wave morphology, presence of atrioventricular (AV) block, QRS axis, presence of ventricular premature contraction, frontal plane QRS-T (f(QRS-T)) angle degree were determined on 12 derivation ECG records. Patient groups were classified as "deceased patient" and "survivors" and the relationship of these parameters with survival was tried to be elucidated.
Results: the frequency of atrial fibrillation was significantly higher in the "deceased patient" group. For patients in sinus rhythm, there was no difference between the two groups in terms of PR distance and 1st degree AV block. Severe AV block was not observed in either group. There was no difference between the two groups in terms of QRS morphology, T wave inversion, and ventricular premature contractions. QRS duration, corrected QTc duration, and frotal plane QRS-T angle values ​​were found to be statistically significantly higher in in the "deceased patient" group.
Conclusion: Atrial fibrillation, prolonged QTc duration and increased frontal plane QRS-T angle can be considered as mortality predictors in COVID-19 infection whose mortality rate is high all over the world.

Anahtar Kelimeler

Covid-19, ECG, AF, QRS-T angle, Mortality

Kaynakça

• Hassan M, Zalkifal M, Wahab A, et al. Novel Coronavirus: A Review from Origin to Current Status of Therapeutic Strategies.Crit Rev Eukaryot Gene Expr 2021; 31: 21-34.
• Alves VP, Casemiro FG, Araujo BG, et al. Factors associated with mortality among elderly people in the COVID-19 pandemic (SARS-CoV-2): a systematic review and meta-analysis. Int J Environ Res Public Health 2021; 18: 8008.
• Ding J, Liu W, Guan H, et al. Corrected QT interval in hospitalized patients with coronavirus disease 2019: focus on drugs therapy. Medicine (Baltimore) 2021; 100: e26538.
• Bertini M, D'Aniello E, Cereda A, et al. The Combination of chest computed tomography and standard electrocardiogram provides prognostic information and pathophysiological insights in COVID-19 pneumonia. J Clin Med 2021; 10: 3031.
• Haji Aghajani M, Toloui A, Aghamohammadi M, et al. Electrocardiographic findings and in-hospital mortality of COVID-19 patients; a retrospective cohort study. Arch Acad Emerg Med 2021; 9: e45.
• McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic findings in coronavirus disease-19: insights on mortality and underlying myocardial processes. J Card Fail 2020; 26: 626-632.
• Lanza GA,De Vita A, Ravenna SE, et al. Electrocardiographic findings at presentation and clinical outcome in patients with SARS-CoV-2 infection. Europace 2021; 23: 123-9.
• Elias P, Poterucha TJ, Jain SS, et al. The prognostic value of electrocardiogram at presentation to emergency department in patients with COVID-19. Mayo Clin Proc 2020; 95: 2099-109.
• Wang Y, Chen L, Wang J, et al. Electrocardiogram analysis of patients with different types of COVID-19. Ann Noninvasive Electrocardiol 2020; 25: e12806.
• Li Y, Liu T, Tse G, et al. Electrocardiograhic characteristics in patients with coronavirus infection: A single-center observational study. Ann Noninvasive Electrocardiol 2020; 25: e12805.
• Hindricks G, Potpara T, Dagres N, et al 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020; 42: 373-98.
• Moss AJ. Measurement of the QT interval and the risk associated with QTc interval prolongation: a review. Am J Cardiol 1993; 72: 23B-25B.
• Hondeghem LM. QT prolongation is an unreliable predictor of ventricular arrhythmia. Heart Rhythm 2008; 5: 1210-2.
• Akhtar Z, Gallagher MM, Yap YG, et al. Prolonged QT predicts prognosis in COVID-19.Pacing Clin Electrophysiol 2021; 44: 875-82.
• Changal K, Paternite D, Mack S, et al. Coronavirus disease 2019 (COVID-19) and QTc prolongation. BMC Cardiovasc Disord 2021; 21: 158.
• Oehler A, Feldman T, Henrikson CA, Tereshchenko LG.QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014; 19: 534-42.
• Gotsman I,Keren A, Hellman Y, Banker J, Lotan C, Zwas DR. Usefulness of electrocardiographic frontal QRS-T angle to predict increased morbidity and mortality in patients with chronic heart failure. Am J Cardiol 2013; 111: 1452-9.
• Aro AL, Huikuri HV, Tikkanen JT, et al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace 2012; 14: 872-6.
• Lown MT, Munyombwe T, Harrison W, et al. Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome. Am J Cardiol 2012; 109: 307-13.
• Liu Y, Mao B, Liang S, et al. Association between age and clinical characteristics and outcomes of COVID-19. Eur Respir J 2020; 55: 5.
• Moraga P, Ketcheson DI, Ombao HC, Duarte CM. Assessing the age- and gender-dependence of the severity and case fatality rates of COVID-19 disease in Spain.Wellcome Open Res 2020; 5: 117.
• Jain AC, Kansal S, Sardana R, Bali RK, Kar S, Chawla R. A retrospective observational study to determine the early predictors of in-hospital mortality at admission with COVID-19. Indian J Crit Care Med 2020; 24: 1174-9.
• Deng F, Zhang L, Lyu L, et al. Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19. Med Clin (Barc) 2021; 156: 324-31.
• Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with COVID-19. J Thromb Haemost 2020; 18: 1324-9.
• Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): evidence from a meta-analysis. Prog Cardiovasc Dis 2020; 63: 390-1.