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Multicenter Study
. 2021 Nov 19;21(1):141.
doi: 10.1186/s12873-021-00539-8.

Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study

Hugo De Carvalho  1 , Lucas Leonard-Pons  2 , Julien Segard  3 , Nicolas Goffinet  1 , François Javaudin  1 , Arnaud Martinage  1 , Guillaume Cattin  1 , Severin Tiberghien  1 , Dylan Therasse  4 , Marc Trotignon  2 , Fabien Arabucki  5 , Simon Ribes  1 , Quentin Le Bastard  1 , Emmanuel Montassier  6
Affiliations
Multicenter Study

Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study

Hugo De Carvalho et al. BMC Emerg Med. .

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be associated with myocardial injury. Identification of at-risk patients and mechanisms underlying cardiac involvement in COVID-19 remains unclear. During hospitalization for COVID-19, high troponin level has been found to be an independent variable associated with in-hospital mortality and a greater risk of complications. Electrocardiographic (ECG) abnormalities could be a useful tool to identify patients at risk of poor prognostic. The aim of our study was to assess if specific ECGs patterns could be related with in-hospital mortality in COVID-19 patients presenting to the ED in a European country.

Methods: From February 1st to May 31st, 2020, we conducted a multicenter study in three hospitals in France. We included adult patients (≥ 18 years old) who visited the ED during the study period, with ECG performed at ED admission and diagnosed with COVID-19. Demographic, comorbidities, drug exposures, signs and symptoms presented, and outcome data were extracted from electronic medical records using a standardized data collection form. The relationship between ECG abnormalities and in-hospital mortality was assessed using univariate and multivariable logistic regression analyses.

Results: An ECG was performed on 275 patients who presented to the ED. Most of the ECGs were in normal sinus rhythm (87%), and 26 (10%) patients had atrial fibrillation/flutter on ECG at ED admission. Repolarization abnormalities represented the most common findings reported in the population (40%), with negative T waves representing 21% of all abnormalities. We found that abnormal axis (adjusted odds ratio: 3.9 [95% CI, 1.1-11.5], p = 0.02), and left bundle branch block (adjusted odds ratio: 7.1 [95% CI, 1.9-25.1], p = 0.002) were significantly associated with in-hospital mortality.

Conclusions: ECG performed at ED admission may be useful to predict death in COVID-19 patients. Our data suggest that the presence of abnormal axis and left bundle branch block on ECG indicated a higher risk of in-hospital mortality in COVID-19 patients who presented to the ED. We also confirmed that ST segment elevation was rare in COVID-19 patients.

Keywords: COVID-19; Electrocardiogram; In-hospital mortality; Patterns.

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Conflict of interest statement

The authors declare that they have no competing interests.

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