Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement
Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement
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DOI：
10.1093/europace/euaa258
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发表时间：
2020-12-01
期刊：
影响因子：
6.1
通讯作者：
Rapezzi, Claudio
中科院分区：
文献类型：
--
作者：
Bertini, Matteo;Ferrari, Roberto;Rapezzi, Claudio
我们的目的是描述COVID-19危重患者的心电图特征。方法和结果我们对2020年3月10日至4月14日期间住院的431例连续死亡或接受有创机械通气治疗的COVID-19患者进行了多中心、横断面、回顾性分析。本项目已在ClinicalTrials.gov上注册（标识符：NCT04367129）。入院时记录标准心电图。93%的患者心电图异常。22%的患者检测到心房颤动/扑动。30%的患者出现急性右心室压力过载（RVPO）的心电图征象。其中43例（10%）为S1Q3T3型，38例（9%）为不完全右束支阻滞（RBBB）， 49例（11%）为完全RBBB。有创机械通气患者（n= 104）与无创机械通气患者（n=327）心电图记录时急性RVPO的心电图体征差异无统计学意义（36% vs. 28%, P = 0.10）。176例（41%）和23例（5%）外周导联出现非特异性复极异常和低QRS电压。在4例显示st段抬高的患者中，冠状动脉造影证实急性心肌梗死。未发现提示急性心肌炎的ST-T异常。在110例可获得高敏感性肌钙蛋白I的患者亚组中，ECG特征在高于或低于5倍参考上限值分层时无统计学差异。结论COVID-19危重症患者心电图几乎全部异常，且异常谱大，30%的患者出现急性RVPO征象。在入院时通过心电图快速、简单地识别这些病例，有助于对患者进行分类，并提供病理生理学的见解。
Aims Our aim was to describe the electrocardiographic features of critical COVID-19 patients.Methods and results We carried out a multicentric, cross-sectional, retrospective analysis of 431 consecutive COVID-19 patients hospitalized between 10 March and 14 April 2020 who died or were treated with invasive mechanical ventilation. This project is registered on ClinicalTrials.gov (identifier: NCT04367129). Standard ECG was recorded at hospital admission. ECG was abnormal in 93% of the patients. Atrial fibrillation/flutter was detected in 22% of the patients. ECG signs suggesting acute right ventricular pressure overload (RVPO) were detected in 30% of the patients. In particular, 43 (10%) patients had the S1Q3T3 pattern, 38 (9%) had incomplete right bundle branch block (RBBB), and 49 (11%) had complete RBBB. ECG signs of acute RVPO were not statistically different between patients with (n = 104) or without (n=327) invasive mechanical ventilation during ECG recording (36% vs. 28%, P = 0.10). Nonspecific repolarization abnormalities and low QRS voltage in peripheral leads were present in 176 (41%) and 23 (5%), respectively. In four patients showing ST-segment elevation, acute myocardial infarction was confirmed with coronary angiography. No ST-T abnormalities suggestive of acute myocarditis were detected. In the subgroup of 110 patients where high-sensitivity troponin I was available, ECG features were not statistically different when stratified for above or below the 5 times upper reference limit value.Conclusions The ECG is abnormal in almost all critically ill COVID-19 patients and shows a large spectrum of abnormalities, with signs of acute RVPO in 30% of the patients. Rapid and simple identification of these cases with ECG at hospital admission can facilitate classification of the patients and provide pathophysiological insights.