Prognostic value of ECG monitor findings in COVID-19

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Abstract

Aims

COVID-19 can cause severe illness and multiorgan dysfunction. Acute myocardial damage has been detected in a significant portion of patients with COVID-19; therefore, several studies have reported that electrocardiographic findings could be used to evaluate the severalty of COVID-19. However, performing standard ECG for each patient hospitalised with COVID-19 can increase the level of exposure to COVID-19 among medical staff. Therefore, this study aimed to investigate the prognostic value of continuous electrocardiographic monitor findings in patients with COVID-19.

Methods

Among 1612 consecutive patients with COVID-19 who were admitted to our hospital between August 2021 and May 2022, we identified 96 (76±4 years) patients who underwent electrocardiographic monitor during hospitalisation. All electrocardiographic monitors were analysed by two independent cardiologists blinded to the clinical data of the patients. The endpoint was defined as the occurrence of all-cause mortality related to COVID-19. The event data were retrospectively gathered from the patients’ medical records. A multivariate Cox model was used to assess whether these electrocardiographic monitor findings and clinical data were associated with in-hospital mortality.

Results

During a mean hospitalisation period of 22.8±3.2 days, in-hospital mortality occurred in 17 (18%) patients. Atrial fibrillation (HR: 3.95, 95% CI: 1.39 to 11.21) and lung disease complications (HR: 2.91, 95% CI: 1.06 to 7.98) were significant prognostic factors for death in multivariate analysis. Compared with the non-complicated lung disease and non-atrial fibrillation group, the risk of mortality was significantly higher in the lung disease complication and atrial fibrillation group in the multivariate Cox proportional model (HR: 8.37, 95% CI: 1.69 to 41.30, p=0.009).

Conclusions

The simple method of ECG monitor could adequately detect atrial fibrillation. This study demonstrated that atrial fibrillation complicated with lung disease, could have potential prognostic value among patients with COVID-19.

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Most cited references 34

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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Author and article information

Journal

Journal ID (nlm-ta): Open Heart

Journal ID (iso-abbrev): Open Heart

Journal ID (hwp): openhrt

Journal ID (publisher-id): openheart

Title: Open Heart

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2053-3624

Publication date Collection: 2023

Publication date (Electronic): 14 November 2023

Volume: 10

Issue: 2

Electronic Location Identifier: e002404

Affiliations

[1 ]departmentDepartment of Cardiovascular Medicine , Ringgold_38436Tokyo Metropolitan Ebara Hospital , Tokyo, Japan

[2 ]departmentDepartment of Cardiovascular Medicine , Toho University Faculty of Medicine , Tokyo, Japan

Author notes

[Correspondence to ] Dr Hidenobu Hashimoto; hidenobu.hashimoto@ 123456med.toho-u.ac.jp

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Hidenobu Hashimoto http://orcid.org/0000-0003-2656-3445

Article

Publisher ID: openhrt-2023-002404

DOI: 10.1136/openhrt-2023-002404

PMC ID: 10649884

PubMed ID: 37963684

SO-VID: f6e8fc1c-691a-4714-b859-2fb139fe0ad9

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 29 June 2023

Date accepted : 31 October 2023

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Keywords: covid-19,atrial fibrillation,electrocardiography

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Keywords: covid-19, atrial fibrillation, electrocardiography

Prognostic value of ECG monitor findings in COVID-19

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Novel Coronavirus Disease COVID-19

Most cited references 34

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

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