Scientists from Tel Aviv Sourasky Medical Center found a simple electrocardiogram (ECG) can pinpoint hospitalized COVID-19 patients at high risk of death who might need intensive management.
They showed that a prolonged QT interval on the ECG was an independent risk factor for both myocardial injury and one-year mortality.
The research was presented at EHRA 2022 and was conducted by Dr. Ariel Banai.
ECG is one of the simplest and fastest tests used to evaluate the heart. The QT interval is a measurement used to assess some of the electrical properties of the heart.
Patients with a prolonged QT interval are at increased risk for life-threatening arrhythmias (heart rhythm disorders) and cardiac arrest.
In the study, the team examined the link between QT prolongation and long-term mortality in patients hospitalized with COVID-19.
It also evaluated the relationship between prolonged QT interval and myocardial injury, a condition in which cells in the heart die.
A total of 335 patients hospitalized with COVID-19 were prospectively studied. All patients had an ECG upon admission.
Patients were deemed to have myocardial injury if they showed reduced function on an echocardiogram, which is an ultrasound of the heart, and/or had troponin in the bloodstream.
Troponin is a protein found only in heart cells. When the heart is damaged, for example in heart injury, troponin is released into the bloodstream.
The team found that compared to those with a normal QT interval, patients with a prolonged QT interval were older (70 years on average versus 63 years), more often had co-existing conditions such as high blood pressure, diabetes and congestive heart failure and presented more frequently with severe (as opposed to mild) COVID-19.
Some 78 patients (71.6%) with QT prolongation had heart injury compared to 110 (48.7%) with a normal QT interval.
Prolonged QT was linked to a two-fold increased risk of myocardial injury.
The team says among patients with myocardial injury, half had no troponin in the blood, suggesting blood tests alone may miss a substantial number of patients with this heart problem.
At one year, 41% of patients in the prolonged QT interval group had died compared to 17% in the normal QT interval group.
QT prolongation was linked to a 1.85-fold increased risk of dying within a year after adjusting for age, co-existing conditions and severity of COVID-19.
The team concluded that one-third of hospitalized COVID-19 patients had a prolonged QT interval.
These patients were generally older and sicker but even after adjusting for these factors, prolonged QT interval was independently linked to worse survival.
More studies are needed to confirm our observations, but the results indicate that ECG assessment could play a role in the risk stratification of patients admitted with COVID-19 infection.
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