Association Between Electrocardiographic Abnormalities and In-Hospital Adverse Outcome in COVID-19 Patients
Article Sidebar
Main Article Content
Abstract
Background: SARS-CoV-2 is increasingly recognized for its cardiovascular complications. To address the knowledge gap in our region, this study investigated the relationship between electrocardiographic (ECG) features and in-hospital mortality among COVID-19 patients.
Methods: A prospective cohort study was conducted involving 140 RT-PCR-confirmed COVID-19 patients at Dhaka Medical College Hospital from August 2021 to July 2022. Patients were divided into two groups based on ECG findings: normal (Group A) and abnormal (Group B). Clinical data and ECG parameters were analyzed using SPSS 24.0.
Results: Patients with abnormal ECGs were older, more likely male, and presented with higher rates of dyspnea and palpitations. They were also at increased risk of severe COVID-19 and had longer hospital stays. In-hospital mortality was significantly higher in Group B (21.4% vs.4.3%). ST-T changes and atrial fibrillation were associated with increased mortality. Independent predictors of in-hospital mortality included ECG abnormalities and admission SpO₂ < 90%.
Conclusion: ECG abnormalities are significantly associated with adverse outcomes in COVID-19 patients. Further large-scale studies are warranted to strengthen these findings.
Article Details
Copyright (c) 2024 Begum A, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Journal of Cardiology and Cardiovascular Medicine is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.
License: Copyright © 2017 - 2025 | 
Open Access by Journal of Cardiology and Cardiovascular Medicine is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.
With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.
Compliance 'CC BY' license helps in:
| Permission to read and download | ✓ |
| Permission to display in a repository | ✓ |
| Permission to translate | ✓ |
| Commercial uses of manuscript | ✓ |
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020;13(5):667–673. Available from: https://doi.org/10.1016/j.jiph.2020.03.019
Ibrahim OR, Suleiman BM, Abdullahi SB, Oloyede T, Sanda A, Gbadamosi MS, et al. Epidemiology of COVID-19 and predictors of outcome in Nigeria: A single-center study. Am J Trop Med Hyg. 2020;103(6):2376-2381. Available from: https://doi.org/10.4269/ajtmh.20-0759
Rahman MR, Sajib EH, Chowdhury IM, Banik A, Bhattacharya R, Ahmed H. Present scenario of COVID-19 in Bangladesh and government preparedness for facing challenges. J Adv Biotechnol Exp Ther. 2021;4(2):187-199. Available from: https://www.bsmiab.org/jabet/178-1611907708-present-scenario-of-covid-19-in-bangladesh-and-government-preparedness-for-facing-challenges
Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75(18):2352-2371. Available from: https://doi.org/10.1016/j.jacc.2020.03.031
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422. Available from: https://doi.org/10.1016/s2213-2600(20)30076-x
Chen C, Zhou Y, Wang DW. SARS-CoV-2: A potential novel etiology of fulminant myocarditis. Herz. 2020;45(3):230-232. Available from: https://doi.org/10.1007/s00059-020-04909-z
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-513. Available from: https://doi.org/10.1016/s0140-6736(20)30211-7
Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17(5):259-260. Available from: https://doi.org/10.1038/s41569-020-0360-5
Antwi-Amoabeng D, Beutler BD, Singh S, Taha M, Ghuman J, Hanfy A, et al. Association between electrocardiographic features and mortality in COVID-19 patients. Ann Noninvasive Electrocardiol. 2021;26(4):1-7. Available from: https://doi.org/10.1111/anec.12833
Aikawa T, Takagi H, Ishikawa K, Kuno T. Myocardial injury characterized by elevated cardiac troponin and in-hospital mortality of COVID-19: An insight from a meta-analysis. J Med Virol. 2021. Available from: https://doi.org/10.1002/jmv.26108
De Carvalho H, Leonard-Pons L, Segard J, Goffinet N, Javaudin F, Martinage A, et al. Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: A multicenter retrospective study. BMC Emerg Med. 2021;21(1):1-7. Available from: https://doi.org/10.1186/s12873-021-00539-8
Rosén J, Noreland M, Stattin K, Lipcsey M, Frithiof R, Malinovschi A, et al. ECG pathology and its association with death in critically ill COVID-19 patients: A cohort study. PLoS ONE. 2021;16(12):1-15. Available from: https://doi.org/10.1371/journal.pone.0261315
Savelloni G, Gatto MC, Cancelli F, Barbetti A, Dezza FC, Franchi C, et al. Prognostic value of 12-leads electrocardiogram at emergency department in hospitalized patients with coronavirus disease-19. Available from: https://doi.org/10.3390/jcm11092537
Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis. 2020;63(3):390. Available from: https://doi.org/10.1016/j.pcad.2020.03.001
Lombardi CM, Carubelli V, Iorio A, Inciardi RM, Bellasi A, Canale C, et al. Association of troponin levels with mortality in Italian patients hospitalized with coronavirus disease 2019: Results of a multicenter study. JAMA Cardiol. 2020;5(11):1274-1280. Available from: https://doi.org/10.1001/jamacardio.2020.3538
McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic findings in coronavirus disease-19: Insights on mortality and underlying myocardial processes. J Card Fail. 2020;26(7):626-632. Available from: https://doi.org/10.1016/j.cardfail.2020.06.005
Romiti GF, Corica B, Lip GYH, Proietti M. Prevalence and impact of atrial fibrillation in hospitalized patients with COVID-19: A systematic review and meta-analysis. J Clin Med. 2021;10(11):2490. Available from: https://doi.org/10.3390/jcm10112490
Yarmohammadi H, Morrow JP, Dizon J, Biviano A, Ehlert F, Saluja D, et al. Frequency of atrial arrhythmia in hospitalized patients with COVID-19. Am J Cardiol. 2021;147:52-57. Available from: https://doi.org/10.1016/j.amjcard.2021.01.039
Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 2015;79(3):495-502. Available from: https://doi.org/10.1253/circj.CJ-15-0138
Awal A, Al Mamun KS, Karim MR, Azad MSU, Ahmed FU. Prognostic value of electrocardiographic abnormalities and troponin-I elevation in hospitalized COVID-19 patients. Bangladesh Heart J. 2021;36(2):105-112. Available from: https://doi.org/10.3329/bhj.v36i2.56036
Hu B, Deng Q, Zhou Q. Cardiac involvement of COVID-19: Looking forward to novel discoveries and clinically valuable evidence. Int J Cardiol. 2020. Available from: https://doi.org/10.1016/j.ijcard.2020.05.049
Kumar S, Arcuri C, Chaudhuri S, Gupta R, Aseri M, Barve P, et al. A novel study on SARS-CoV-2 virus associated bradycardia as a predictor of mortality: Retrospective multicenter analysis. Clin Cardiol. 2021;44(6):857-862. Available from: https://doi.org/10.1002/clc.23622
Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020;15(11). Available from: https://doi.org/10.1371/journal.pone.0241955
Karbalai Saleh S, Oraii A, Soleimani A, Hadadi A, Shajari Z, Montazeri M, et al. The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med. 2020;15(8):1415-1424. Available from: https://doi.org/10.1007/s11739-020-02466-1