Petrovsky Russian Scientific Center of Surgery, Moscow.
Buyanov Municipal Clinical Hospital, Moscow.
Kardiologiia. 2022 Dec 31;62(12):30-37. doi: 10.18087/cardio.2022.12.n2260.
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; р=0.01), MSCT data (RR, 1.54; 95 % CI: 1.14-2.092; р=0.005), and glomerular filtration rate (GFR) (RR, 0.98; 95 % CI: 0.96-0.99; р=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 125 ms (р=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 (р=0.038). The presence of LBBB was associated with reduced LV EF (р=0.0078). The presence of atrial fibrillation (AF) significantly predetermines a worse outcome both at the start (р=0.011) and at the end of observation (р=0.034). A higher mortality was observed for the group of deceased patients with ST segment deviations, ST elevation (р=0.0059) and ST depression (р=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.
目的 确定主要心电图（ECG）参数对 COVID-19 患者预后的影响。
材料与方法 COVID-19 的全身表现之一是心脏损伤。心电图是诊断心脏损伤最简便、最有效的方法，它影响着治疗方法。本研究纳入了 174 名住院 COVID-19 患者。分析入院时和出院前或患者死亡前记录的主要心电图参数及其变化，并确定每个参数对住院预后的影响。结果与左心室射血分数（LV EF）、实验室数据和肺部多层螺旋 CT（MSCT）结果进行比较。
结果 入院时的心电图数据不同，出院和死亡患者的变化也不同。特别引人关注的是基线和治疗结束时 QRS 波群持续时间对住院生存率和死亡率的影响。Cox 回归分析显示，QRS 波群持续时间（相对风险（RR）2.07，95%置信区间（CI）：1.17-3.66；p=0.01）、MSCT 数据（RR，1.54；95%CI：1.14-2.092；p=0.005）和肾小球滤过率（GFR）（RR，0.98；95%CI：0.96-0.99；p=0.001）具有最高的预测意义。在对这三个指标的进一步比较中，QRS 持续时间和 GFR 仍然具有预测意义，ROC 分析显示 QRS 复合波群持续时间的截断值为 125ms（p=0.001）。在疾病过程中发生左束支传导阻滞（LBBB）的患者与其他室内传导障碍患者预后不良（p=0.038）。LBBB 与左心室射血分数降低有关（p=0.0078）。心房颤动（AF）的存在在开始时（p=0.011）和观察结束时（p=0.034）都显著预示着预后更差。ST 段偏移、ST 段抬高（p=0.0059）和 ST 段压低（p=0.028）的死亡患者组观察到更高的死亡率。
结论 因此，QTc 间期延长、治疗期间发生的 LBBB、AF 和 QRS 波群持续时间增加是决定 COVID-19 患者住院预后的指标。对预后不良最强的心电图预测指标是 QRS 波群持续时间，它允许将患者分层为风险组。
