Ventricular repolarization heterogeneity in patients with COVID-19: Original data, systematic review, and meta-analysis

Abstract

Background: Coronavirus disease-2019 (COVID-19) has been associated with an increased risk of acute cardiac events. However, the effect of COVID-19 on repolarization heterogeneity is not yet established. In this study, we evaluated electrocardiogram (ECG) markers of repolarization heterogeneity in patients hospitalized with COVID-19. In addition, we performed a systematic review and meta-analysis of the published studies.

Methods: QT dispersion (QTd), the interval between T wave peak to T wave end (TpTe), TpTe/QT (with and without correction), QRS width, and the index of cardio-electrophysiological balance (iCEB) were calculated in 101 hospitalized COVID-19 patients and it was compared with 101 non-COVID-19 matched controls. A systematic review was performed in four databases and meta-analysis was conducted using Stata software.

Results: Tp-Te, TpTe/QT, QRS width, and iCEB were significantly increased in COVID-19 patients compared with controls (TpTe = 82.89 vs. 75.33 ms (ms), p-value = .005; TpTe/QT = 0.217 vs. 0.203 ms, p-value = .026). After a meta-analysis of 679 COVID-19 cases and 526 controls from 9 studies, TpTe interval, TpTe/QT, and TpTe/QTc ratios were significantly increased in COVID-19 patients. Meta-regression analysis moderated by age, gender, diabetes mellitus, hypertension, and smoking reduced the heterogeneity. QTd showed no significant correlation with COVID-19.

Conclusion: COVID-19 adversely influences the ECG markers of transmural heterogeneity of repolarization. Studies evaluating the predictive value of these ECG markers are warranted to determine their clinical utility.

Keywords: COVID-19; QT dispersion; T-peak to T-end; electrocardiography; repolarization disparity; repolarization heterogeneity; sudden cardiac death.

Figure 1

Flowchart showing the screening process of systematic review results

Figure 2

Meta‐analysis of ECG markers of repolarization heterogeneity mean difference between two study groups. CI, confidence interval; COVID‐19, coronavirus disease 2019; MD, mean difference; SD, standard deviation

Figure 3

A schematic description of variables affecting on cardiac electrical stability in the course of COVID‐19. (The flash sign represents adrenergic stimulation, ARDS, acute respiratory distress syndrome; SIRS, systemic inflammatory response syndrome, PTE, pulmonary thromboembolism, ACS, acute coronary syndrome, RV, right ventricle, TpTe, T wave peak to T wave end)