Savelloni Giulia, Gatto Maria Chiara, Cancelli Francesca, Barbetti Anna, Cogliati Dezza Francesco, Franchi Cristiana, Carnevalini Martina, Galardo Gioacchino, Bucci Tommaso, Alessandroni Maria, Pugliese Francesco, Mastroianni Claudio Maria, Oliva Alessandra
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
Department of Clinical, Internal Medicine and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy.
J Clin Med. 2022 Apr 30;11(9):2537. doi: 10.3390/jcm11092537.
Background: Electrocardiogram (ECG) offers a valuable resource easily available in the emergency setting. Objective: Aim of the study was to describe ECG alterations on emergency department (ED) presentation or that developed during hospitalization in SARS-CoV-2-infected patients and their association with 28-day mortality. Methods: A retrospective, single-center study including hospitalized patients with SARS-CoV-2 was conducted. ECG was recorded on ED admission to determine: heart rhythm, rate, and cycle; atrio-ventricular and intra-ventricular conduction; right ventricular strain; and ventricular repolarization. A specialized cardiologist blinded for the outcomes performed all 12-lead ECG analyses and their interpretation. Results: 190 patients were included, with a total of 24 deaths (12.6%). Age (p < 0.0001) and comorbidity burden were significantly higher in non-survivors (p < 0.0001). Atrial fibrillation (AF) was more frequent in non-survivors (p < 0.0001), alongside a longer QTc interval (p = 0.0002), a lower Tp-e/QTc ratio (p = 0.0003), and right ventricular strain (p = 0.013). Remdesivir administration was associated with bradycardia development (p = 0.0005) but no increase in mortality rates. In a Cox regression model, AF (aHR 3.02 (95% CI 1.03−8.81); p = 0.042), QTc interval above 451 ms (aHR 3.24 (95% CI 1.09−9.62); p = 0.033), and right ventricular strain (aHR 2.94 (95% CI 1.01−8.55); p = 0.047) were associated with higher 28-day mortality risk. Conclusions: QTc interval > 451 ms, right ventricular strain, and AF are associated with higher mortality risk in SARS-CoV-2 hospitalized patients. ECG recording and its appropriate analysis offers a simple, quick, non-expensive, and validated approach in the emergency setting to guide COVID-19 patients’ stratification.
心电图（ECG）是一种在紧急情况下易于获取的宝贵资源。目的：本研究旨在描述严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者在急诊科（ED）就诊时或住院期间出现的心电图改变及其与28天死亡率的关联。方法：进行了一项回顾性单中心研究，纳入了SARS-CoV-2感染的住院患者。在ED入院时记录心电图，以确定：心律、心率和心动周期；房室和室内传导；右心室应变；以及心室复极化。由一位对结果不知情的专业心脏病专家进行所有12导联心电图分析及其解读。结果：共纳入190例患者，其中24例死亡（12.6%）。非幸存者的年龄（p<0.0001）和合并症负担显著更高（p<0.0001）。非幸存者中房颤（AF）更为常见（p<0.0001），同时QTc间期更长（p = 0.0002），Tp-e/QTc比值更低（p = 0.0003），以及右心室应变（p = 0.013）。使用瑞德西韦与心动过缓的发生相关（p = 0.0005），但死亡率没有增加。在Cox回归模型中，房颤（调整后风险比[aHR] 3.02[95%置信区间（CI）1.03 - 8.81]；p = 0.042）、QTc间期超过451毫秒（aHR 3.24[95% CI 1.09 - 9.62]；p = 0.033）和右心室应变（aHR 2.94[95% CI 1.01 - 8.55]；p = 0.047）与28天更高的死亡风险相关。结论：QTc间期>451毫秒、右心室应变和房颤与SARS-CoV-2住院患者更高的死亡风险相关。心电图记录及其适当分析为紧急情况下指导2019冠状病毒病（COVID-19）患者分层提供了一种简单、快速、廉价且经过验证的方法。
