Kimata Motohiro, Hashimoto Kenichi, Harada Naomi, Kawamura Yusuke, Kimizuka Yoshifumi, Fujikura Yuji, Kaneko Mayuko, Kiriu Nobuaki, Sekine Yasumasa, Iwabuchi Natsumi, Kiyozumi Tetsuro, Kawana Akihiko, Matsukuma Susumu, Tanaka Yuji
Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan.
Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan.
Medicina (Kaunas). 2024 Apr 19;60(4):655. doi: 10.3390/medicina60040655.
Coronavirus disease 2019 (COVID-19) has affected medical practice. More than 7,000,000 patients died worldwide after being infected with COVID-19; however, no specific laboratory markers have yet been established to predict death related to this disease. In contrast, electrocardiographic changes due to COVID-19 include QT prolongation and ST-T changes; however, there have not been studies on the ambulatory electrocardiographic markers of COVID-19. We encountered three patients diagnosed as having COVID-19 who did not have a prior history of significant structural heart diseases. All patients had abnormalities in ambulatory echocardiogram parameters detected by high-resolution 24 h electrocardiogram monitoring: positive late potentials (LPs) and T-wave alternans (TWA), abnormal heart rate variability (HRV), and heart rate turbulence (HRT). Case 1 involved a 78-year-old woman with a history of chronic kidney disease, Case 2 involved a 76-year-old man with hypertension and diabetes, and Case 3 involved a 67-year-old man with renal cancer, lung cancer, and diabetes. None of them had a prior history of significant structural heart disease. Although no significant consistent increases in clinical markers were observed, all three patients died, mainly because of respiratory failure with mild heart failure. The LP, TWA, HRV, and HRT were positive in all three cases with no significant structural cardiac disease at the initial phase of admission. The further accumulation of data regarding ambulatory electrocardiographic markers in patients with COVID-19 is needed. Depending on the accumulation of data, the LP, TWA, HRV, and HRT could be identified as potential risk factors for COVID-19 pneumonia in the early phase of admission.
2019年冠状病毒病（COVID-19）对医疗实践产生了影响。全球有超过700万患者在感染COVID-19后死亡；然而，尚未建立用于预测该疾病相关死亡的特定实验室标志物。相比之下，COVID-19引起的心电图变化包括QT间期延长和ST-T改变；然而，尚未有关于COVID-19动态心电图标志物的研究。我们遇到了3例被诊断为COVID-19且既往无严重结构性心脏病病史的患者。所有患者通过高分辨率24小时心电图监测检测到动态超声心动图参数异常：晚期电位（LP）和T波交替（TWA）阳性、心率变异性（HRV）异常以及心率震荡（HRT）异常。病例1是一名78岁有慢性肾病病史的女性，病例2是一名76岁有高血压和糖尿病的男性，病例3是一名67岁患有肾癌、肺癌和糖尿病的男性。他们均无既往严重结构性心脏病病史。尽管未观察到临床标志物有显著一致的升高，但这3例患者均死亡，主要原因是呼吸衰竭合并轻度心力衰竭。在入院初期，这3例无严重结构性心脏病的患者LP、TWA、HRV和HRT均为阳性。需要进一步积累COVID-19患者动态心电图标志物的数据。根据数据积累情况，LP、TWA、HRV和HRT可能会被确定为入院早期COVID-19肺炎的潜在危险因素。
