Department of Cardiology, Ashford and St Peter's NHS trust, Chertsey, Surrey, UK.
Department of Cardiology, St George's University Hospital, London, UK.
Pacing Clin Electrophysiol. 2021 May;44(5):875-882. doi: 10.1111/pace.14232. Epub 2021 Apr 13.
Coronavirus disease-2019 (COVID-19) causes severe illness and multi-organ dysfunction. An abnormal electrocardiogram is associated with poor outcome, and QT prolongation during the illness has been linked to pharmacological effects. This study sought to investigate the effects of the COVID-19 illness on the corrected QT interval (QTc).
For 293 consecutive patients admitted to our hospital via the emergency department for COVID-19 between 01/03/20 -18/05/20, demographic data, laboratory findings, admission electrocardiograph and clinical observations were compared in those who survived and those who died within 6 weeks. Hospital records were reviewed for prior electrocardiograms for comparison with those recorded on presentation with COVID-19.
Patients who died were older than survivors (82 vs 69.8 years, p < 0.001), more likely to have cancer (22.3% vs 13.1%, p = 0.034), dementia (25.6% vs 10.7%, p = 0.034) and ischemic heart disease (27.8% vs 10.7%, p < 0.001). Deceased patients exhibited higher levels of C-reactive protein (244.6 mg/L vs 146.5 mg/L, p < 0.01), troponin (1982.4 ng/L vs 413.4 ng/L, p = 0.017), with a significantly longer QTc interval (461.1 ms vs 449.3 ms, p = 0.007). Pre-COVID electrocardiograms were located for 172 patients; the QTc recorded on presentation with COVID-19 was longer than the prior measurement in both groups, but was more prolonged in the deceased group (448.4 ms vs 472.9 ms, pre-COVID vs COVID, p < 0.01). Multivariate Cox-regression analysis revealed age, C-reactive protein and prolonged QTc of >455 ms (males) and >465 ms (females) (p = 0.028, HR 1.49 [1.04-2.13]), as predictors of mortality. QTc prolongation beyond these dichotomy limits was associated with increased mortality risk (p = 0.0027, HR 1.78 [1.2-2.6]).
QTc prolongation occurs in COVID-19 illness and is associated with poor outcome.
2019 年冠状病毒病（COVID-19）可导致严重疾病和多器官功能障碍。异常心电图与不良预后相关，疾病期间的 QT 延长与药物作用有关。本研究旨在探讨 COVID-19 疾病对校正 QT 间期（QTc）的影响。
对 2020 年 3 月 1 日至 5 月 18 日期间因 COVID-19 通过急诊科收治的 293 例连续患者进行研究，比较了 6 周内存活和死亡患者的人口统计学数据、实验室检查结果、入院心电图和临床观察结果。对住院记录进行了回顾性分析，以比较与 COVID-19 就诊时记录的心电图。
死亡患者比存活患者年龄更大（82 岁 vs 69.8 岁，p<0.001），更有可能患有癌症（22.3% vs 13.1%，p=0.034）、痴呆症（25.6% vs 10.7%，p=0.034）和缺血性心脏病（27.8% vs 10.7%，p<0.001）。死亡患者的 C 反应蛋白（244.6 mg/L vs 146.5 mg/L，p<0.01）和肌钙蛋白（1982.4 ng/L vs 413.4 ng/L，p=0.017）水平更高，QTc 间隔明显更长（461.1 ms vs 449.3 ms，p=0.007）。找到 172 名患者的 COVID-19 前心电图；在两组中，COVID-19 就诊时记录的 QTc 均长于既往测量值，但在死亡组中更长（448.4 ms vs 472.9 ms，COVID-19 前 vs COVID-19，p<0.01）。多变量 Cox 回归分析显示，年龄、C 反应蛋白和 QTc 延长>455 ms（男性）和>465 ms（女性）（p=0.028，HR 1.49 [1.04-2.13]）是死亡的预测因素。超过这些二分位数限制的 QTc 延长与死亡率增加相关（p=0.0027，HR 1.78 [1.2-2.6]）。
QTc 延长发生在 COVID-19 疾病中，与不良预后相关。
