The effect of the severity of COVID-19 infection on electrocardiographic findings

Background and Aim: Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of between 7% and 28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). Method(s): A total of 219 patients that were hospitalized due to COVID-19 between April 15 and May 5, 2020 were enrolled in this study. Patients were divided into two groups according to the severity of COVID-19 infection: severe (n = 95) and non-severe (n = 124). ECG findings at the time of admission were recorded for each patient. Clinical characteristics and laboratory findings were retrieved from electronic medical records. Result(s): Mean age was 65.2 +/- 13.8 years in the severe group and was 57.9 +/- 16.0 years in the non-severe group. ST depression (28% vs 14%), T-wave inversion (29% vs 16%), ST-T changes (36% vs 21%), and the presence of fragmented QRS (fQRS) (17% vs 7%) were more frequent in the severe group compared to the non-severe group. Multivariate analysis revealed that hypertension (odds ratio [OR]: 2.42, 95% confidence interval [CI]:1.03-5.67;P = .041), the severity of COVID-19 infection (OR: 1.87, 95% CI: 1.09-2.65;p=0.026), presence of cardiac injury (OR: 3.32, 95% CI: 1.45-7.60;p=0.004), and d-dimer (OR: 3.60, 95% CI: 1.29-10.06;p=0.014) were independent predictors of ST-T changes on ECG. Conclusion(s): ST depression, T-wave inversion, ST-T changes, and the presence of fQRS on admission ECG are closely associated with the severity of COVID-19 infection.

Echocardiographic features of patients with COVID-19 infection

Background and Aim: COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. Method(s): For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. Result(s): A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n=44) was 63.3+/-15.7 years, and 54% were male. The mean age of non-severe group (n=46) was 49.7+/-21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6+/-5.9 mm vs 33.1+/-4.8 mm, p=0.003;LV 47.3+/-5.8 mm vs. 44.9+/-3.8 mm, p=0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0+/-9.8% vs 61.9+/-4.8%, p<0.001;RV-FAC, 41.4+/-4.1% vs 45.5+/-4.5%, p<0.001), and pericardial effusions were more frequent (23% vs 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. Conclusion(s): The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses.

Prognostic significance of Tp-e interval and Tp-e/QTc ratio in patients with COVID-19

OBJECTIVE: Ventricular arrhythmias were the most frequent manifestations in patients with COVID-19. Both the natural course of the disease and the treatment drugs used have effects on ventricular repolarization. The objective of this study was to evaluate the effects of repolarization parameters obtained from surface electrocardiography (ECG) on prognosis. PATIENTS AND METHODS: Participants were 205 consecutive patients hospitalized with COVID-19 diagnosis. The 12-lead surface ECG was obtained from each patient on admission. The ECG results were evaluated against the patients' clinical characteristics and outcomes by experienced cardiology specialists. RESULTS: The mean age was higher in the non-survivor group compared to the survivor group (57.4 +/- 15.7 vs. 65.6 +/- 16.6;p = 0.001). The demographical characteristics were similar between the survivor and non-survivor groups. Multivariate analyses demonstrated that age (OR: 1.041;p = 0.009), D-dimer (OR: 1.002;p = 0.031), high-sensitivity troponin I (hs-TnI) (OR: 1.010;p = 0.041), pneumonia on computed tomography (CT) (OR: 4.985;p < 0.001), the peak-to-end interval of the T wave (Tp-e) (OR: 3.421;p < 0.001), and Tp-e/QTc ratio (OR: 1.978;p = 0.013) were statistically significant independent predictors in terms of determining mortality. CONCLUSIONS: Prolonged Tp-e interval and increased Tp-e/QTc ratio on admission are decent predictors and linked with mortality. ECG is a practical study to evaluate prognosis and potential arrhythmias, as well as initiating suitable treatment.

Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography

Background and Aim: A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). Methods: In this prospective, single-center study, data were gathered from patients treated for COVID-19 between April 15 and April 30, 2020. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. Results: A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n=44) was 59.1±12.9, 40% of whom were male. The mean age of the non-severe group (n=56) was 53.7±15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LVGLS: -14.5±1.8 vs. -16.7±1.3 vs. -19.4±1.6, respectively [p<0.001];RV-LS: -17.2±2.3 vs. -20.5±3.2 vs. -27.3±3.1, respectively [p<0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR:1.63, 95% confidence interval [CI] 1.08-2.47;p=0.010) and RV-LS (OR:1.55, 95% CI 1.07-2.25;p=0.019) were identified as independent predictors of mortality via multivariate analysis. Conclusions: LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.

Procalcitonin is a predictor of disseminated intravascular coagulation in patients with fatal COVID-19.

OBJECTIVE: The coagulopathies that present with COVID-19 are thrombotic microangiopathy and disseminated intravascular coagulopathy (DIC). Procalcitonin (PCT) levels have been shown to be significantly increased in COVID-19 patients in comparison with healthy subjects/asymptomatic coronavirus-positive patients. In this report, our aim was to assess the associations of the PCT level with DIC and the severity of COVID-19 infection. PATIENTS AND METHODS: In this cross-sectional, retrospective study, 71 consecutive patients with severe COVID-19 (21 with DIC and 50 without DIC) were enrolled in the study. The PCT level was obtained from hospital records. RESULTS: The PCT level was significantly higher in the patients with DIC than in those without DIC [1.9 (0.6-14.5) vs. 0.3 (0.2-0.4) (ng/mL), p<0.01]. The PCT level showed a positive and significant correlation with DIC (r=0.382, p=0.001) and was an independent predictor of DIC in patients with severe COVID-19 (OR: 6.685, CI: 1.857-24.063, p<0.01). CONCLUSIONS: In summary, the PCT level was increased in severe COVID-19 patients with DIC compared with those without DIC. An increased PCT level might suggest the presence of DIC and may help in predicting COVID-19 severity.