Tondas Alexander Edo, Munawar Dian Andina, Marcantoni Ilaria, Liberty Iche Andriyani, Mulawarman Rido, Hadi Muhammad, Trifitriana Monica, Indrajaya Taufik, Yamin Muhammad, Irfannuddin Irfannuddin, Burattini Laura
Department of Cardiology and Vascular Medicine, Mohammad Hoesin General Hospital, Palembang, Sumatera Selatan, Indonesia.
Biomedicine Doctoral Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia.
Cardiol Res. 2023 Feb;14(1):45-53. doi: 10.14740/cr1458. Epub 2023 Feb 25.
Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology.
Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method.
A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33).
Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.
心律失常与2019冠状病毒病（COVID-19）患者的不良预后显著相关。微伏级T波交替（TWA）可自动定量，并且已被认为是复极异质性的一种表现，并与各种心血管疾病中的心律失常发生有关。本研究旨在探讨微伏级TWA与COVID-19病理之间的相关性。
使用Alivecor Kardiamobile 6L™便携式心电图（ECG）设备对穆罕默德·霍辛综合医院疑似COVID-19的患者进行连续评估。严重COVID-19患者或无法配合主动进行心电图自我记录的患者被排除在研究之外。使用新型增强自适应匹配滤波器（EAMF）方法检测TWA并对其幅度进行定量。
本研究共纳入175例患者，其中114例COVID-19患者（聚合酶链反应（PCR）阳性组）和61例非COVID-19患者（PCR阴性组）。PCR阳性组根据COVID-19病理严重程度细分为轻度和中度严重程度亚组。两组入院时的基线TWA水平相似（42.47±26.52微伏对44.72±38.21微伏），但与PCR阴性组相比，PCR阳性组出院时观察到更高的TWA水平（53.45±34.42微伏对25.15±17.64微伏，P = 0.03）。在调整其他混杂变量后，COVID-19中的PCR阳性结果与TWA值之间的相关性显著（R = 0.081，P = 0.030）。COVID-19患者轻度和中度严重程度亚组之间的TWA水平在入院时（4,429±27.14微伏对3,675±24.46微伏，P = 0.34）和出院时（4,947±33.62微伏对6,109±35.99微伏，P = 0.33）均无显著差异。
在PCR阳性的COVID-19患者出院时获得的随访心电图上可观察到更高TWA值。
