Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study.
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Samat Azlan Helmy Abd, Cassar Mark P, Akhtar Abid M, McCracken Celeste, Ashkir Zakariye M, Mills Rebecca, Moss Alastair J, Finnigan Lucy E M, Lewandowski Adam J, Mahmod Masliza, Ogbole Godwin I, Tunnicliffe Elizabeth M, Lukaschuk Elena, Piechnik Stefan K, Ferreira Vanessa M, Nikolaidou Chrysovalantou, Rahman Najib M, Ho Ling-Pei, Harris Victoria C, Singapuri Amisha, Manisty Charlotte, O'Regan Declan P, Weir-McCall Jonathan R, Steeds Richard P, Llm Krisnah Poinasamy, Cuthbertson Dan J, Kemp Graham J, Horsley Alexander, Miller Christopher A, O'Brien Caitlin, Chiribiri Amedeo, Francis Susan T, Chalmers James D, Plein Sven, Poener Ana-Maria, Wild James M, Treibel Thomas A, Marks Michael, Toshner Mark, Wain Louise V, Evans Rachael A, Brightling Christopher E, Neubauer Stefan, McCann Gerry P, Raman Betty, PHOSP-COVID Collaborative group
Аннотация
METHODS: Post-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.
RESULTS: At a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47-0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55-0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.
CONCLUSION: Post-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.