J-waves in acute COVID-19: A novel disease characteristic and predictor of mortality?

Abstract

Background: J-waves represent a common finding in routine ECGs (5-6%) and are closely linked to ventricular tachycardias. While arrhythmias and non-specific ECG alterations are a frequent finding in COVID-19, an analysis of J-wave incidence in acute COVID-19 is lacking.

Methods: A total of 386 patients consecutively, hospitalized due to acute COVID-19 pneumonia were included in this retrospective analysis. Admission ECGs were analyzed, screened for J-waves and correlated to clinical characteristics and 28-day mortality.

Results: J-waves were present in 12.2% of patients. Factors associated with the presence of J-waves were old age, female sex, a history of stroke and/or heart failure, high CRP levels as well as a high BMI. Mortality rates were significantly higher in patients with J-waves in the admission ECG compared to the non-J-wave cohort (J-wave: 14.9% vs. non-J-wave 3.8%, p = 0.001). After adjusting for confounders using a multivariable cox regression model, the incidence of J-waves was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15-6.63; p = 0.023). J-waves disappeared or declined in 36.4% of COVID-19 survivors with available ECGs for 6-8 months follow-up.

Conclusion: J-waves are frequently and often transiently found in the admission ECG of patients hospitalized with acute COVID-19. Furthermore, they seem to be an independent predictor of 28-day mortality.

Fig 1. Study design.

Fig 2. Independent predictors of 28-day mortality from COVID-19 in multivariable logistic-regression analysis.

Results are reported as odds ratios (OR) and 95% confidence intervals (CIs). AF–atrial fibrillation, AH–arterial hypertension, CHD–coronary heart diseases, CKD–chronic kidney disease, Hb–hemoglobin. *p<0.050.

Fig 3

a) Kaplan-Maier survival curves of patients with COVID-19 with (blue) and without (red) J-waves within 28 days. b) Kaplan-Maier multiplier survival values within 28 days from hospitalization in patients with COVID-19. c) Survival rates difference between J- and no J-wave patients.

Fig 4

a) Admission ECG (10mm/mV&50mm/s) of a 74-year-old female (patient 1) with COVID-19 pneumonia presenting J-waves (blue arrow). During hospitalization, the patient developed respiratory failure, required mechanical ventilation and died on the 20^th day upon admission. b-c) Limb leads recording from 12-lead ECGs of a 72-year-old male (patient 2) admitted to hospital with COVID-19 pneumonia b) At admission J-waves were revealed (blue arrow) on the limb recordings (5mm/mV&50mm/s) but the patients could be successfully discharged on 13^th day upon hospitalization. c.) During follow-up at eight months, ECG (10mm/mV&50mm/s) performed in an outpatient clinic revealed a resolution of J-waves.