A simple electrocardiogram (ECG) can identify hospitalized COVID-19 patients at high risk of death, who may require intensive management, according to a study. Research suggests that a prolonged QT interval on an ECG was an independent risk factor for both heart injury and one-year mortality.
The QT interval refers to the electrical signal from the moment the ventricles or heart chambers contract until they finish resting and is measured in milliseconds. Patients with a prolonged QT interval have an increased risk of life-threatening arrhythmias – heart rhythm disorders – and heart failure.
“An ECG is an inexpensive, non-invasive, readily obtainable and widely available test that is applicable in almost all hospitalized patients,” said study lead author Ariel Banai from Tel Aviv Sourasky Medical Center, Israel. “Our study shows that a simple ECG tracing done upon admission can help healthcare professionals triage patients with COVID-19 and identify those in need of intensive care,” Banai said. said.
An ECG records electrical activity as it travels through the heart. The information is displayed as a graph which is divided into segments by location in the heart. The study, presented at EHRA 2022, a scientific conference of the European Society of Cardiology (ESC), examined the association between QT prolongation and long-term mortality in patients hospitalized with COVID-19. It also evaluated the relationship between a prolonged QT interval and myocardial injury, a condition in which heart cells die.
Researchers studied 335 consecutive patients hospitalized with COVID-19. All of them had ECG done at the time of admission. Patients were considered to have myocardial injury if they showed reduced function on an echocardiogram, which is an ultrasound of the heart, and had troponin in the bloodstream.
Troponin is a protein found only in heart cells. When the heart is damaged, for example in myocardial injury, troponin is released into the bloodstream. Patients were divided into two groups according to the duration of the QT interval: 109 patients (32.5 percent) had a prolonged QT interval and 226 patients (67.5 percent) had a normal QT interval.
Compared with those with a normal QT interval, patients with a prolonged QT interval were older (median 70 years versus 63 years). The researchers said that 78 patients had myocardial injury with QT prolongation, compared to 110 with a normal QT interval.
They noted that prolonged QT was associated with a two-fold increased risk of myocardial injury after adjusting for age, co-existing conditions and severity of COVID-19. “Interestingly, half of the patients with myocardial injury did not have troponin in their blood, suggesting that the blood test alone may have missed a significant number of patients with this heart problem,” Bani said. At one year, 41 percent of patients prolong the QT interval. According to the researchers, the group had died compared to 17 percent in the normal QT interval group.
They said QT prolongation was associated with a 1.85-fold increased risk of dying within one year after adjusting for age, co-existing conditions and severity of COVID-19. When patients were divided into four groups according to the presence of myocardial injury and QT prolongation, those with both conditions had a 6.6 times higher chance of one-year mortality than patients without QT prolongation and no myocardial injury. Was.
“In our study, a third of the hospitalized COVID-19 patients had a prolonged QT interval,” Banai said. “These patients were generally older and sicker, but even after adjusting for these factors, a prolonged QT interval was independently associated with worse survival,” the researcher said.
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