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Minerva Medica 2022 August;113(4):667-74

DOI: 10.23736/S0026-4806.21.07894-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Prognostic value of 12-leads admission electrocardiogram in low-risk patients hospitalized for COVID-19

Martino PEPE 1 , Gianluigi NAPOLI 1, Gaetano BRINDICCI 2, Eugenio CARULLI 1, Palma L. NESTOLA 1, Carmen R. SANTORO 2, Giuseppe BIONDI-ZOCCAI 3, 4, Arturo GIORDANO 5, Fabrizio D’ASCENZO 6, Plinio CIRILLO 7, Annalisa SARACINO 2, 8, Stefano FAVALE 1

1 Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), Aldo Moro University of Bari, Bari, Italy; 2 Clinic of Infectious Diseases, Policlinic Hospital of Bari, Bari, Italy; 3 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; 4 Mediterranea Cardiocentro, Naples, Italy; 5 Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy; 6 Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; 7 Division of Cardiology, University of Naples Federico II, Naples, Italy; 8 Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy



BACKGROUND: Cardiac involvement significantly contributes to coronavirus disease 2019 (COVID-19) mortality.12-lead electrocardiogram (ECG) represents a fast, cheap, and easy to perform exam with the adjunctive advantage of the remote reporting possibility. In this study, we sought to investigate if electrocardiographic parameters can identify patients, deemed at low-risk at admission, who will face in-hospital unfavorable course.
METHODS: From March 1, 2020, through March 30, 2021, 384 consecutive patients with confirmed low-risk COVID-19 were hospitalized at the University Hospital of Bari (Italy). Criteria for low risk were: admission to the division of Pneumology or Infectious Diseases, no need for immediate (within 24 hours from admission) transfer to Intensive Care Unit or for respiratory support with invasive mechanical ventilation (IMV) or for circulation support (either mechanical or pharmacological). Admission ECGs were reviewed and interpreted by two expert cardiologists. The primary outcomes were in-hospital death and the composite outcome of in-hospital death and IMV.
RESULTS: In low-risk COVID-19 patients, atrial fibrillation (AF), poor R wave progression (PRWP), tachycardia, and right bundle branch block (RBBB) resulted as statistically significant and independent predictors of in-hospital all-cause mortality; AF, PRWP, Tachycardia, RBBB, and corrected QT interval showed to be statistically significant and independent risk factors for the occurrence of the composite endpoint of death and IMV.
CONCLUSIONS: Our study demonstrated for the first time that RBBB and PRWP, assessed upon admission with ECG, are associated with unfavorable clinical course in a baseline low-risk population hospitalized for COVID-19.


KEY WORDS: COVID-19; Electrocardiography; Atrial fibrillation; Bundle-branch block

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