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Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes

  • Author Footnotes
    ⁎ Drs. McCullough and Goyal contributed equally to this work and are joint first authors.
    S. ANDREW MCCULLOUGH
    Footnotes
    ⁎ Drs. McCullough and Goyal contributed equally to this work and are joint first authors.
    Affiliations
    Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
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  • Author Footnotes
    ⁎ Drs. McCullough and Goyal contributed equally to this work and are joint first authors.
    PARAG GOYAL
    Footnotes
    ⁎ Drs. McCullough and Goyal contributed equally to this work and are joint first authors.
    Affiliations
    Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York

    Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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  • UDHAY KRISHNAN
    Affiliations
    Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
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  • JUSTIN J. CHOI
    Affiliations
    Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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  • MONIKA M. SAFFORD
    Affiliations
    Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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  • PETER M. OKIN
    Correspondence
    Reprint requests: Peter M. Okin, MD, Department of Medicine, Cornell Medical Center, 525 East 68th Street, New York, NY 10065. Phone: 1-212-746-4688.
    Affiliations
    Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
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  • Author Footnotes
    ⁎ Drs. McCullough and Goyal contributed equally to this work and are joint first authors.

      Highlights

      • Findings of left and right sided heart disease on the presentation electrocardiogram are associated with death in COVID-19
      • Right bundle branch block in COVID-19 is likely secondary to acute right ventricular distension, and could represent the at-risk right ventricle.
      • Markers of left ventricular stiffness (atrial premature contractions, prolonged intraventricular conduction, and ischemic repolarization abnormalities) are associated with death.

      Abstract

      Background

      Coronavirus disease 2019 (COVID-19) is a respiratory syndrome with high rates of mortality, and there is a need for easily obtainable markers to provide prognostic information. We sought to determine whether the electrocardiogram (ECG) on hospital presentation provides prognostic information, specifically related to death.

      Methods and Results

      We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics and ECG variables were manually abstracted from the electronic health record and first ECG. Our primary outcome was death.

      There were

      756 patients who presented to a large New York City teaching hospital with COVID-19 who underwent an ECG. The mean age was 63.3 ± 16 years, 37% were women, 61% of patients were nonwhite, and 57% had hypertension; 90 (11.9%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.23–5.36, P = .01), a right bundle branch block or intraventricular block (OR 2.61, 95% CI 1.32–5.18, P = .002), ischemic T-wave inversion (OR 3.49, 95% CI 1.56–7.80, P = .002), and nonspecific repolarization (OR 2.31, 95% CI 1.27–4.21, P = .006) increased the odds of death. ST elevation was rare (n = 5 [0.7%]).

      Conclusions

      We found that patients with ECG findings of both left-sided heart disease (atrial premature contractions, intraventricular block, repolarization abnormalities) and right-sided disease (right bundle branch block) have higher odds of death. ST elevation at presentation was rare.

      Graphical Abstract

      Keywords

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