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Observational Study
. 2020 Dec;59(3):485-493.
doi: 10.1007/s10840-020-00896-7. Epub 2020 Oct 31.

T-wave inversion as a manifestation of COVID-19 infection: a case series

Jorge Romero  1 , Isabella Alviz  1 , Michael Parides  1 , Juan Carlos Diaz  1 , David Briceno  1 , Mohamed Gabr  1 , Maria Gamero  1 , Kavisha Patel  1 , Eric D Braunstein  1 , Sutopa Purkayastha  1 , Dalvert Polanco  1 , Carolina R Valencia  1 , Domenico Della Rocca  2 , Alejandro Velasco  1 , Ruike Yang  1 , Nicola Tarantino  1 , Xiao-Dong Zhang  1 , Sanghamitra Mohanty  2 , Juan Bello  1 , Andrea Natale  2 , Ulrich P Jorde  1 , Mario Garcia  1 , Luigi Di Biase  3   4
Affiliations
Observational Study

T-wave inversion as a manifestation of COVID-19 infection: a case series

Jorge Romero et al. J Interv Card Electrophysiol. 2020 Dec.

Abstract

Purpose: Cardiac involvement with COVID-19 infection has become evident by elevated troponin, cardiac arrhythmias, ST segment elevation, myocarditis, fulminant heart failure, and sudden cardiac death. We aimed to describe the association of COVID-19 and T-wave inversion (TWI) in a large case series.

Methods: We conducted an observational, retrospective study of confirmed COVID-19 cases with at least one electrocardiogram (ECG) in a large hospital in New York City (March 23, 2020-April 23, 2020). Patients with new TWI or pseudonormalization were further analyzed. Mortality and the need for invasive mechanical ventilation were the main outcomes.

Results: A total of 3225 patients were screened; 195 (6%) were selected for further analysis: 181 with TWI and 14 with T-wave pseudonormalization. Mean age was 66 ± 7 years; 51% were male. TWI were more commonly noted in the lateral (71%), followed by anterior (64%), inferior (57%), and septal (26%) leads. A total of 44 patients (23%) had elevated troponin. A total of 50 patients died (26%). Mortality rates of 35%, and 52% were observed in patients with diffuse TWI, and elevated troponin, respectively. Mortality rate of 80% was observed in patients with both elevated troponin and diffuse TWI. Additionally, 30% of the entire cohort and 58% of patients with elevated troponin required invasive mechanical ventilation.

Conclusion: Our study demonstrates that new TWI is a relatively common finding in COVID-19 patients. Importantly, our findings suggest that new TWI or T-wave pseudonormalization, particularly with elevated troponin, was associated with higher rates of mechanical ventilation and in-hospital mortality.

Keywords: COVID 19; ECG abnormality; Mortality; T-wave inversion.

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Conflict of interest statement

Dr. Di Biase is a consultant for Biosense Webster, Stereotaxis, Boston Scientific, and Abbott; has received speaker honoraria/travel from Biosense Webster, Abbott, Boston Scientific, Medtronic, Atricure, Pfizer, and Biotronik. The remaining authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
a Distribution of T-wave inversion (TWI) on 12-lead ECG. b Number of cardiac walls involved with TWI on 12-lead ECG. ECG: electrocardiogram, TWI: T-wave inversion
Fig. 2
Fig. 2
a ECG showing T-waves inversion (TWI) in one cardiac wall (lateral leads), b ECG with TWI in two cardiac walls (anterolateral leads), c TWI in three cardiac walls (anterolateral with inferior leads), d TWI in all cardiac walls. ECG: electrocardiogram, TWI: T-wave inversion
Fig. 3
Fig. 3
Overall mortality in the study and mortality rates in different subgroups. TWI: T-wave inversion
See this image and copyright information in PMC

Comment in

  • Prolonged QT predicts prognosis in COVID-19.
    Akhtar Z, Gallagher MM, Yap YG, Leung LWM, Elbatran AI, Madden B, Ewasiuk V, Gregory L, Breathnach A, Chen Z, Fluck DS, Sharma S. Akhtar Z, et al. Pacing Clin Electrophysiol. 2021 May;44(5):875-882. doi: 10.1111/pace.14232. Epub 2021 Apr 13. Pacing Clin Electrophysiol. 2021. PMID: 33792080 Free PMC article.

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