Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy.
IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
J Interv Card Electrophysiol. 2022 Mar;63(2):441-448. doi: 10.1007/s10840-021-01033-8. Epub 2021 Jul 22.
Systemic inflammation has been associated with corrected QT (QTc) interval prolongation. The role of inflammation on QTc prolongation in COVID-19 patients was investigated.
Patients with a laboratory-confirmed SARS-CoV-2 infection admitted to IRCCS San Raffaele Scientific Institute (Milan, Italy) between March 14, 2020, and March 30, 2020 were included. QTc-I was defined as the QTc interval by Bazett formula in the first ECG performed during the hospitalization, before any new drug treatment; QTc-II was the QTc in the ECG performed after the initiation of hydroxychloroquine drug treatment.
QTc-I was long in 45 patients (45%) and normal in 55 patients (55%). Patients with long QTc-I were older and more frequently males. C-Reactive protein (CRP) and white blood cell (WBC) count at hospitalization were higher in patients with long QTc-I and long QTc-II. QTc-I was significantly correlated with CRP levels at hospitalization. After a median follow-up of 83 days, 14 patients (14%) died. There were no deaths attributed to ventricular arrhythmias. Patients with long QTc-I and long QTc-II had a shorter survival, compared with normal QTc-I and QTc-II patients, respectively. In Cox multivariate analysis, independent predictors of mortality were age (HR = 1.1, CI 95% 1.04-1.18, p = 0.002) and CRP at ECG II (HR 1.1, CI 95% 1.0-1.1, p = 0.02).
QTc at hospitalization is a simple risk marker of mortality risk in COVID-19 patients and reflects the myocardial inflammatory status.
全身炎症与校正 QT（QTc）间期延长有关。本研究旨在探讨炎症在 COVID-19 患者 QTc 延长中的作用。
纳入 2020 年 3 月 14 日至 2020 年 3 月 30 日期间因实验室确诊的 SARS-CoV-2 感染而入住意大利米兰圣拉斐尔科学研究所（IRCCS San Raffaele Scientific Institute）的患者。QTc-I 定义为住院期间首次心电图检查（入院后任何新的药物治疗前）时的 Bazett 公式校正 QT 间期；QTc-II 为羟氯喹药物治疗开始后心电图的 QTc 间期。
45 例（45%）患者的 QTc-I 延长，55 例（55%）患者的 QTc-I 正常。QTc-I 延长的患者年龄较大，男性比例较高。住院时 C 反应蛋白（CRP）和白细胞（WBC）计数较高的患者 QTc-I 和 QTc-II 延长。QTc-I 与住院时 CRP 水平显著相关。中位随访 83 天后，14 例患者（14%）死亡。没有因室性心律失常而死亡。与 QTc-I 和 QTc-II 正常的患者相比，QTc-I 和 QTc-II 延长的患者存活率较低。在 Cox 多变量分析中，死亡的独立预测因素为年龄（HR=1.1，95%CI 1.04-1.18，p=0.002）和心电图 II 时的 CRP（HR 1.1，95%CI 1.0-1.1，p=0.02）。
住院时的 QTc 是 COVID-19 患者死亡风险的一个简单的风险标志物，反映了心肌炎症状态。
