Clinical and cardiac characteristics of COVID-19 mortalities in a diverse New York City Cohort
Clinical and cardiac characteristics of COVID-19 mortalities in a diverse New York City Cohort
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DOI：
10.1111/jce.14772
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发表时间：
2020-10-20
影响因子：
2.7
通讯作者：
Saluja, Deepak
中科院分区：
文献类型：
--
作者：
Abrams, Mark P.;Wan, Elaine Y.;Saluja, Deepak
导言新冠肺炎相关死亡的心电图特征尚未见报道，特别是在少数民族中。方法和结果我们回顾了2020年3月1日至4月3日在纽约市三家医院住院的SARS-CoV-2逆转录聚合酶链式反应阳性患者的人口学特征、实验室和心脏测试、药物治疗以及濒临死亡或开始舒适护理的心律。我们描述了临床特征，并比较了导致心律失常死亡和非心律失常死亡的因素。在1258名筛查的患者中，有133人死亡并入选。其中男性占55.6%(74/133)，少数民族占69.9%(93/133)，心血管疾病占88.0%(117/133)。最后记录到的心律失常为室性心动过速或纤颤5.3%(7/133)，无脉性电活动7.5%(10/133)，心动过缓0.8%(1/133)，停搏26.3%(35/133)。大多数74.4%(99/133)的患者仅接受舒适性治疗而死亡。入院时最常见的异常有QRS轴异常(25.8%)、房颤/扑动(14.3%)、心房异位(12.0%)、右束支传导阻滞(11.9%)。住院期间，17.6%的患者发生了房颤，14.7%的患者出现了室颤，10.1%的患者出现了房颤/扑动，7.8%的患者出现了右室异常。与年龄、冠状动脉疾病、哮喘、血管加压药的使用、入院校正QT间期延长和左束支传导阻滞(LBBB)相关的心律失常死亡确诊率或可疑死亡率为8.3%(11/133)。结论新冠肺炎相关住院期间，传导、节律和心电图异常较为常见。心律失常死亡与年龄、冠状动脉疾病、哮喘、较长的入院校正QT间期、LBBB、室性异位和血管增压药的使用有关。大多数人在接受舒适措施时死亡。
Introduction Electrocardiographic characteristics in COVID-19-related mortality have not yet been reported, particularly in racial/ethnic minorities. Methods and Results We reviewed demographics, laboratory and cardiac tests, medications, and cardiac rhythm proximate to death or initiation of comfort care for patients hospitalized with a positive SARS-CoV-2 reverse-transcriptase polymerase chain reaction in three New York City hospitals between March 1 and April 3, 2020 who died. We described clinical characteristics and compared factors contributing toward arrhythmic versus nonarrhythmic death. Of 1258 patients screened, 133 died and were enrolled. Of these, 55.6% (74/133) were male, 69.9% (93/133) were racial/ethnic minorities, and 88.0% (117/133) had cardiovascular disease. The last cardiac rhythm recorded was VT or fibrillation in 5.3% (7/133), pulseless electrical activity in 7.5% (10/133), unspecified bradycardia in 0.8% (1/133), and asystole in 26.3% (35/133). Most 74.4% (99/133) died receiving comfort measures only. The most common abnormalities on admission electrocardiogram included abnormal QRS axis (25.8%), atrial fibrillation/flutter (14.3%), atrial ectopy (12.0%), and right bundle branch block (11.9%). During hospitalization, an additional 17.6% developed atrial ectopy, 14.7% ventricular ectopy, 10.1% atrial fibrillation/flutter, and 7.8% a right ventricular abnormality. Arrhythmic death was confirmed or suspected in 8.3% (11/133) associated with age, coronary artery disease, asthma, vasopressor use, longer admission corrected QT interval, and left bundle branch block (LBBB). Conclusions Conduction, rhythm, and electrocardiographic abnormalities were common during COVID-19-related hospitalization. Arrhythmic death was associated with age, coronary artery disease, asthma, longer admission corrected QT interval, LBBB, ventricular ectopy, and usage of vasopressors. Most died receiving comfort measures.