COVID-19 患者的心电图随时间的变化及其预后价值。
Electrocardiographic findings over time and their prognostic value in patients with COVID-19.
机构信息
School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, China; Sichuan Provincial Key Laboratory for Ultrasound in Cardiac Electrophysiology and Biomechanics, Chengdu, China.
Sichuan Province Public Health Clinical Medical Center, Chengdu, China.
出版信息
Ann Palliat Med. 2021 Dec;10(12):12280-12290. doi: 10.21037/apm-21-3188.
BACKGROUND
The objective of this study was to carry out a retrospective analysis of the progression of electrocardiographic (ECG) findings over time, based on biomarkers for myocardial injuries in patients with coronavirus disease 2019 (COVID-19). Also, the ECG observations were assessed for possible prognostic use.
METHODS
Diagnostic criteria provided by the Coronavirus Pneumonia Diagnosis and Treatment Program of the Chinese National Health Commission were used. We conducted a retrospective analysis of 31 COVID-19 cases diagnosed as positive by high-throughput sequencing of nasopharyngeal nucleic acid test and admitted to Sichuan Province Public Health Clinical Medical Center, Sichuan Province, China. Based on changes in biomarkers, the 31 participants were divided into a non-myocardial injury group (A) and a myocardial injury group (B). Our study observed the dynamic changes and new abnormal changes of the ECG during the hospitalization of patients.
RESULTS
The results summarized in the 4 following points: (I) the time sequence changes for ST and T indicated that the absolute ST-segment depression and T-wave inversion values in group B were larger. (II) The heart rate (HR) and RV5 values in group B were higher, the QTC value for group B was lower. (III) The sensitivity of ST-segment depression for the diagnosis of myocardial injury was 32.60% and the specificity was 90.50%. The sensitivity of T-wave inversion was 41.30% and the specificity was 85.10%. (IV) Lactate dehydrogenase (LDH) is a major factor affecting patient's death.
CONCLUSIONS
If abnormal ST-T, increased heart rate, shortened QTC interval, and high ventricular voltage are observed in a COVID-19 patient, it may infer that myocardial damage has occurred. Using ECG as a point of reference for change can compensate for the time limitation of myocardial enzyme index. Regardless of the stage of disease development, ECG can reflect myocardial damage. Particularly in the 8-12 days after hospitalization, almost all myocardial enzymes cannot be applied. The ST-depression and T-wave inversion had diagnostic significance with relatively high sensitivity and specificity for myocardial injury. Assessment of LDH and biomarkers in combination with ECG can more accurately reflect myocardial injury, and facilitate prompt clinical diagnosis and treatment.
背景
本研究旨在基于 2019 年冠状病毒病（COVID-19）患者心肌损伤的生物标志物，对心电图（ECG）结果随时间的进展进行回顾性分析。还评估了 ECG 观察结果的可能预后用途。
方法
使用中国国家卫生健康委员会冠状病毒肺炎诊断与治疗方案提供的诊断标准。我们对在中国四川省公共卫生临床医疗中心住院的 31 例经高通量测序鼻咽核酸检测阳性确诊为 COVID-19 的病例进行了回顾性分析。根据生物标志物的变化，将 31 名患者分为非心肌损伤组（A）和心肌损伤组（B）。我们的研究观察了患者住院期间 ECG 的动态变化和新的异常变化。
结果
总结了以下 4 点结果：（I）ST 和 T 的时间序列变化表明，B 组的绝对 ST 段压低和 T 波倒置值更大。（II）B 组的心率（HR）和 RV5 值较高，B 组的 QTC 值较低。（III）ST 段压低诊断心肌损伤的敏感性为 32.60%，特异性为 90.50%。T 波倒置的敏感性为 41.30%，特异性为 85.10%。（IV）乳酸脱氢酶（LDH）是影响患者死亡的主要因素。
结论
如果在 COVID-19 患者中观察到异常的 ST-T、心率增加、缩短的 QTC 间隔和高心室电压，可能推断发生了心肌损伤。使用 ECG 作为变化的参考点可以弥补心肌酶指标的时间限制。无论疾病发展阶段如何，ECG 都可以反映心肌损伤。特别是在住院后 8-12 天，几乎所有心肌酶都无法应用。ST 压低和 T 波倒置对心肌损伤具有诊断意义，具有较高的敏感性和特异性。评估 LDH 和与 ECG 相结合的生物标志物可以更准确地反映心肌损伤，并有助于及时进行临床诊断和治疗。
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