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. 2021 May;361(5):591-597.
doi: 10.1016/j.amjms.2020.12.012. Epub 2021 Feb 10.

Wide QRS Complex and Lateral ST-T Segment Abnormality Are Associated With Worse Clinical Outcomes in COVID-19 Patients

Mehmet Rasih Sonsoz  1 , Aytac Oncul  2 , Erdem Cevik  2 , Huseyin Orta  2 , Mustafa Yilmaz  2 , Elif Ayduk Govdeli  2 , Asli Nalbant  2 , Zeynep Gizem Demirtakan  2 , Mirac Tonyali  2 , Damla Durmus  2 , Ilkay Anakli  3 , Ozlem Polat  3 , Yunus Catma  4 , Naci Senkal  4 , Alpay Medetalibeyoglu  4 , Murat Kose  4 , Samim Emet  2 , Tufan Tukek  4
Affiliations

Wide QRS Complex and Lateral ST-T Segment Abnormality Are Associated With Worse Clinical Outcomes in COVID-19 Patients

Mehmet Rasih Sonsoz et al. Am J Med Sci. 2021 May.

Abstract

Background: The information on electrocardiographic features of patients with coronavirus disease 2019 (COVID-19) is limited. Our aim was to determine if baseline electrocardiographic features of hospitalized COVID-19 patients are associated with markers of myocardial injury and clinical outcomes.

Methods: In this retrospective, single center cohort study, we included 223 hospitalized patients with laboratory-confirmed COVID-19. Clinical, electrocardiographic and laboratory data were collected and analyzed. Primary composite endpoint of mortality, need for invasive mechanical ventilation, or admission to the intensive care unit was assessed.

Results: Forty patients (17.9%) reached the primary composite endpoint. Patients with the primary composite endpoint were more likely to have wide QRS complex (>120 ms) and lateral ST-T segment abnormality. The multivariable Cox regression showed increasing odds of the primary composite endpoint associated with acute respiratory distress syndrome (odds ratio 7.76, 95% CI 2.67-22.59; p < 0.001), acute cardiac injury (odds ratio 3.14, 95% CI 1.26-7.99; p = 0.016), high flow oxygen therapy (odds ratio 2.43, 95% CI 1.05-5.62; p = 0.037) and QRS duration longer than >120 ms (odds ratio 3.62, 95% CI 1.39-9.380; p = 0.008) Patients with a wide QRS complex (>120 ms) had significantly higher median level of troponin T and pro-BNP than those without it. Patients with abnormality of lateral ST-T segment had significantly higher median level of troponin T and pro-BNP than patients without.

Conclusions: The presence of QRS duration longer than 120 ms and lateral ST-T segment abnormality were associated with worse clinical outcomes and higher levels of myocardial injury biomarkers.

Keywords: COVID-19; Electrocardiogram; Mortality; Myocardial injury; Wide QRS complex.

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Figures

Fig 1
Figure 1
A. Bar graph demonstrating statistically significant higher level of median high sensitive troponin T in patients with a wide QRS complex (>120 ms) compared to patients without it. B. Bar graph showing statistically significant higher level of median pro-BNP in patients with a wide QRS complex (>120 ms) compared to patients without it. C. Comparison of median high sensitive troponin T levels among patients with various ST-T segment abnormality. D. Comparison of median pro-BNP levels among patients with various ST-T segment abnormality.
See this image and copyright information in PMC

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