ABSTRACT
Aim To determine the effect of major electrocardiographic (ECG) parameters on the prognosis of patients with COVID-19.Material and methods One of systemic manifestations of COVID-19 is heart injury. ECG is the most simple and available method for diagnosing the heart injury, which influences the therapeutic approach. This study included 174 hospitalized patients with COVID-19. Major ECG parameters recorded on admission and their changes before the discharge from the hospital or death of the patient, were analyzed, and the effect of each parameter on the in-hospital prognosis was determined. Results were compared with the left ventricular ejection fraction (LV EF), laboratory data, and results of multispiral computed tomography (MSCT) of the lungs.Results ECG data differed on admission and their changes differed for deceased and discharged patients. Of special interest was the effect of the QRS complex duration at baseline and at the end of treatment on the in-hospital survival and mortality rate. The Cox regression analysis showed that the QRS complex duration (relative risk (RR) 2.07, 95% confidence interval (CI): 1.17-3.66; Ñ=0.01), MSCT data (RR, 1.54; 95â% CI: 1.14-2.092; Ñ=0.005), and glomerular filtration rate (GFR) (RR, 0.98; 95â% CI: 0.96-0.99; Ñ=0.001) had the highest predictive significance. In further comparison of these three indexes, the QRS duration and GFR retained their predictive significance, and a ROC analysis showed that the cut-off QRS complex duration was 125âms (Ñ=0.001). Patients who developed left bundle branch block (LBBB) in the course of disease also had an unfavorable prognosis compared to other intraventricular conduction disorders (Ñ=0.038). The presence of LBBB was associated with reduced LV EF (Ñ=0.0078). The presence of atrial fibrillation (AF) significantly predetermines a worse outcome both at the start (Ñ=0.011) and at the end of observation (Ñ=0.034). A higher mortality was observed for the group of deceased patients with ST segment deviations, ST elevation (Ñ=0.0059) and ST depression (Ñ=0.028).Conclusion Thus, the QTc interval elongation, LBBB that developed during the treatment, AF, and increased QRS complex duration are the indicators that determine the in-hospital prognosis of patients with COVID-19. The strongest electrocardiographic predictor for an unfavorable prognosis was the QRS complex duration that allowed stratification of patients to groups of risk.
Subject(s)
Atrial Fibrillation , COVID-19 , Heart Injuries , Humans , Stroke Volume , Ventricular Function, Left , COVID-19/diagnosis , Prognosis , Electrocardiography/methods , Bundle-Branch Block , HospitalsABSTRACT
Background Heart damage is one of complications of the novel coronavirus infection. Searching for available predictors for in-hospital death and survival that determine the tactic of managing patients with COVID-19, is a challenge of the present time.Aim To determine the role echocardiographic (EchoCG) parameters in evaluation of the in-hospital prognosis for patients with the novel coronavirus infection, COVID-19.Material and methods The study included 158 patients admitted for COVID-19. EchoCG was performed for all patients. The role of left ventricular (LV) ejection fraction (EF) was analyzed in various age groups. EchoCG data were compared with the clinical picture, including the severity of respiratory failure (RF), blood oxygen saturation (SÑÐ2), data of computed tomography (CT) of the lungs, and blood concentration of troponin. Comorbidity was analyzed, and the highest significance of individual pathologies was determined.Results LV EF ≤40â% determined the worst prognosis of patients with COVID-19 (p<0.0001), including the age group older than 70 years (Ñ=0.013). LV EF did not correlate with the degree of lung tissue damage determined by CT upon admission (Ñ=0.54) and over time (Ñ=0.23). The indexes that determined an adverse in-hospital prognosis to a considerable degree were pericardial effusion (p<0.0001) and pulmonary hypertension (p<0.0001). RV end-diastolic dimension and LV end-diastolic volume did not determine the in-hospital mortality and survival. Blood serum concentration of troponin I higher than 165.13 µg/l was an important predictor for in-hospital death with a high degree of significance (Ñ<0.0001). Th degree of RF considerably influenced the in-hospital mortality (Ñ<0.0001). RF severity was associated with LV EF (Ñ=0.024). The SpO2 value determined an adverse immediate prognosis with a high degree of significance (Ñ=0.0009). This parameter weakly correlated with LV EF (r=0.26; p=0.0009). Patients who required artificial ventilation (AV) constituted a group with the worst survival rate (Ñ<0.0001). LV EF was associated with a need for AV with a high degree of significance (Ñ=0.0006). Comorbidities, such as chronic kidney disease, postinfarction cardiosclerosis and oncologic diseases, to the greatest extent determined the risk of fatal outcome.Conclusion EchoCG can be recommended for patients with COVID-19 at the hospital stage to determine the tactics of management and for the in-hospital prognosis.