Korean Circ J.  2021 Oct;51(10):851-862. 10.4070/kcj.2021.0116.

Electrocardiographic Manifestations in Patients with COVID-19: Daegu in South Korea

• Bae HJ
• Cho HJ
• Lee CH
• Bae MH
• Park HS
• Jung BC
• Shin DG
• Cho Y
• Hwang J
• Han S
• Park KH
• Jang SY
• Lee YS

• KMID: 2520692
• DOI: http://doi.org/10.4070/kcj.2021.0116

Abstract

Background and Objectives
As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients.
Methods
Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]).
Results
Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746–42.306).
Conclusions
COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.

Keyword

Coronavirus; COVID-19; ECG

Figure

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  Figure 1 Dispersion of corrected QT and peak to end of T wave (Tpe) according to clinical severity score. (A) Dispersion of corrected QT (B) Dispersion of corrected Tpe. Red line is mean, and box lesion is quartile.QTc = corrected QT.

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  Figure 2 Dispersion of corrected QT and Tpe according to mortality. (A) Dispersion of corrected QT (B) Dispersion of corrected Tpe. Red line is mean, and box lesion is quartile.QTc = corrected QT.

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  Figure 3 QTc and T peak to end dispersion according to mortality by age group.QTc = corrected QT.

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