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Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19

Background: Electrocardiogram (ECG) offers a valuable resource easily available in the emergency setting. Objective: Aim of the study was to describe ECG alterations on emergency department (ED) presentation or that developed during hospitalization in SARS-CoV-2-infected patients and their associati...

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Autores principales: Savelloni, Giulia, Gatto, Maria Chiara, Cancelli, Francesca, Barbetti, Anna, Cogliati Dezza, Francesco, Franchi, Cristiana, Carnevalini, Martina, Galardo, Gioacchino, Bucci, Tommaso, Alessandroni, Maria, Pugliese, Francesco, Mastroianni, Claudio Maria, Oliva, Alessandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9100038/
https://www.ncbi.nlm.nih.gov/pubmed/35566664
http://dx.doi.org/10.3390/jcm11092537
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author Savelloni, Giulia
Gatto, Maria Chiara
Cancelli, Francesca
Barbetti, Anna
Cogliati Dezza, Francesco
Franchi, Cristiana
Carnevalini, Martina
Galardo, Gioacchino
Bucci, Tommaso
Alessandroni, Maria
Pugliese, Francesco
Mastroianni, Claudio Maria
Oliva, Alessandra
author_facet Savelloni, Giulia
Gatto, Maria Chiara
Cancelli, Francesca
Barbetti, Anna
Cogliati Dezza, Francesco
Franchi, Cristiana
Carnevalini, Martina
Galardo, Gioacchino
Bucci, Tommaso
Alessandroni, Maria
Pugliese, Francesco
Mastroianni, Claudio Maria
Oliva, Alessandra
author_sort Savelloni, Giulia
collection PubMed
description Background: Electrocardiogram (ECG) offers a valuable resource easily available in the emergency setting. Objective: Aim of the study was to describe ECG alterations on emergency department (ED) presentation or that developed during hospitalization in SARS-CoV-2-infected patients and their association with 28-day mortality. Methods: A retrospective, single-center study including hospitalized patients with SARS-CoV-2 was conducted. ECG was recorded on ED admission to determine: heart rhythm, rate, and cycle; atrio-ventricular and intra-ventricular conduction; right ventricular strain; and ventricular repolarization. A specialized cardiologist blinded for the outcomes performed all 12-lead ECG analyses and their interpretation. Results: 190 patients were included, with a total of 24 deaths (12.6%). Age (p < 0.0001) and comorbidity burden were significantly higher in non-survivors (p < 0.0001). Atrial fibrillation (AF) was more frequent in non-survivors (p < 0.0001), alongside a longer QTc interval (p = 0.0002), a lower Tp-e/QTc ratio (p = 0.0003), and right ventricular strain (p = 0.013). Remdesivir administration was associated with bradycardia development (p = 0.0005) but no increase in mortality rates. In a Cox regression model, AF (aHR 3.02 (95% CI 1.03–8.81); p = 0.042), QTc interval above 451 ms (aHR 3.24 (95% CI 1.09–9.62); p = 0.033), and right ventricular strain (aHR 2.94 (95% CI 1.01–8.55); p = 0.047) were associated with higher 28-day mortality risk. Conclusions: QTc interval > 451 ms, right ventricular strain, and AF are associated with higher mortality risk in SARS-CoV-2 hospitalized patients. ECG recording and its appropriate analysis offers a simple, quick, non-expensive, and validated approach in the emergency setting to guide COVID-19 patients’ stratification.
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spelling pubmed-91000382022-05-14 Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19 Savelloni, Giulia Gatto, Maria Chiara Cancelli, Francesca Barbetti, Anna Cogliati Dezza, Francesco Franchi, Cristiana Carnevalini, Martina Galardo, Gioacchino Bucci, Tommaso Alessandroni, Maria Pugliese, Francesco Mastroianni, Claudio Maria Oliva, Alessandra J Clin Med Article Background: Electrocardiogram (ECG) offers a valuable resource easily available in the emergency setting. Objective: Aim of the study was to describe ECG alterations on emergency department (ED) presentation or that developed during hospitalization in SARS-CoV-2-infected patients and their association with 28-day mortality. Methods: A retrospective, single-center study including hospitalized patients with SARS-CoV-2 was conducted. ECG was recorded on ED admission to determine: heart rhythm, rate, and cycle; atrio-ventricular and intra-ventricular conduction; right ventricular strain; and ventricular repolarization. A specialized cardiologist blinded for the outcomes performed all 12-lead ECG analyses and their interpretation. Results: 190 patients were included, with a total of 24 deaths (12.6%). Age (p < 0.0001) and comorbidity burden were significantly higher in non-survivors (p < 0.0001). Atrial fibrillation (AF) was more frequent in non-survivors (p < 0.0001), alongside a longer QTc interval (p = 0.0002), a lower Tp-e/QTc ratio (p = 0.0003), and right ventricular strain (p = 0.013). Remdesivir administration was associated with bradycardia development (p = 0.0005) but no increase in mortality rates. In a Cox regression model, AF (aHR 3.02 (95% CI 1.03–8.81); p = 0.042), QTc interval above 451 ms (aHR 3.24 (95% CI 1.09–9.62); p = 0.033), and right ventricular strain (aHR 2.94 (95% CI 1.01–8.55); p = 0.047) were associated with higher 28-day mortality risk. Conclusions: QTc interval > 451 ms, right ventricular strain, and AF are associated with higher mortality risk in SARS-CoV-2 hospitalized patients. ECG recording and its appropriate analysis offers a simple, quick, non-expensive, and validated approach in the emergency setting to guide COVID-19 patients’ stratification. MDPI 2022-04-30 /pmc/articles/PMC9100038/ /pubmed/35566664 http://dx.doi.org/10.3390/jcm11092537 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Savelloni, Giulia
Gatto, Maria Chiara
Cancelli, Francesca
Barbetti, Anna
Cogliati Dezza, Francesco
Franchi, Cristiana
Carnevalini, Martina
Galardo, Gioacchino
Bucci, Tommaso
Alessandroni, Maria
Pugliese, Francesco
Mastroianni, Claudio Maria
Oliva, Alessandra
Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
title Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
title_full Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
title_fullStr Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
title_full_unstemmed Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
title_short Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19
title_sort prognostic value of 12-leads electrocardiogram at emergency department in hospitalized patients with coronavirus disease-19
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9100038/
https://www.ncbi.nlm.nih.gov/pubmed/35566664
http://dx.doi.org/10.3390/jcm11092537
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