Asemptomatik COVID-19 ve ventriküler aritmiler arasındaki ilişkinin belirlenmesi
Year 2021,
Volume: 46 Issue: 1, 101 - 107, 31.03.2021
Fatih Çölkesen
,
Yakup Alsancak
,
Hülya Vatansev
,
Fatma Çölkesen
,
Esma Kepenek
Abstract
Amaç: Elektrokardiyografi (EKG), herhangi bir hastalıkta ve COVID-19 hastalarında kardiyak tutulumu değerlendirmek için ilk seçenek tanı aracıdır. Bu çalışmanın amacı, COVID-19'un ventriküler aritmilere yatkınlık oluşturan etkisini araştırmak ve tedaviye rehberlik etmektir.
Gereç ve Yöntem: Asemptomatik COVID-19 nedeniyle takip edilen 74 hasta (ortalama yaş 52.63 ± 17.85 yıl) ve 74 sağlıklı gönüllü (ortalama yaş 50.71 ± 6.02 yıl) çalışmaya dahil edildi. Kalp hızı, QRS süresi, QT mesafesi, T dalgası morfolojisi (Tp-e aralığı), Tp-e / QT oranı ve kardiyak elektrofizyolojik denge indeksi (iCEB) analiz edildi ve her iki grup arasında karşılaştırıldı.
Bulgular: COVID-19 grubunda EKG'de kalp hızı daha yüksekti ve QT aralığı daha kısaydı. QTc aralığı, Tp-e aralıkları ve Tp-e / QT oranı açısından gruplar arasında farklılık yoktu. Ayrıca, iCEB ve iCEB-c değerleri gruplar arasında farklı değildi. COVID-19'lu hastalarda CRP ve troponin değerleri arasında anlamlı ancak zayıf pozitif bir korelasyon gözlendi. COVID-19'lu hastalarda troponin seviyeleri ile Tp-e / QT oranı ve iCEB arasında korelasyon yoktu.
Sonuç: COVID-19'un kronik kardiyak etkileri aydınlatılamamıştır. Bunu ortaya çıkarmak için uzun vadeli ve çok sayıda hasta popülasyonu içeren prospektif klinik araştırmalara ihtiyaç vardır. Özellikle, troponin değerleri önemli ölçüde yüksek olan hastalar, uzun süreli kardiyomiyopati ve aritmi gelişimi açısından izlenmelidir
Supporting Institution
Yok
References
- 1. Huang, C., et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020. 395(10223): p. 497-506.
- 2. Sohrabi, C., et al., World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International Journal of Surgery, 2020.
- 3. Wang, D., et al., Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 2020.
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- 15. Shimizu, M., et al., T‐peak to T‐end interval may be a better predictor of high‐risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease, 2002. 25(7): p. 335-339.
- 16. Hevia, J.C., et al., Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. Journal of the American College of Cardiology, 2006. 47(9): p. 1828-1834.
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- 18. Kuipers, S., P.M. Klein Klouwenberg, and O.L. Cremer, Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care, 2014. 18(6): p. 688.
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- 20. Kochi, A.N., et al., Cardiac and arrhythmic complications in patients with COVID‐19. Journal of Cardiovascular Electrophysiology, 2020.
- 21. Cetin, S., et al., Assessment of Tp-e interval and Tp-e/QT ratio in patients with human immunodeficiency virus. Revista Portuguesa de Cardiologia, 2020.
- 22. Demir, C. and M. Demir, Evaluation of Tp-e interval and Tp-e/QT ratio in patients with chronic hepatitis B. Prague Med Rep, 2013. 114(4): p. 239-45.
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Evaluation of association between asymptomatic COVID-19 and ventricular arrhythmias
Year 2021,
Volume: 46 Issue: 1, 101 - 107, 31.03.2021
Fatih Çölkesen
,
Yakup Alsancak
,
Hülya Vatansev
,
Fatma Çölkesen
,
Esma Kepenek
Abstract
Purpose: Electrocardiography (ECG) is the first-line diagnostic tool to evaluate cardiac involvement in any disease and COVID-19 patients. The objective of this study is to investigate the ventricular arrhythmia forming effect of COVID-19 and to guide the treatment.
Materials and Methods: A total of 74 patients (mean age 52.63±17.85 years) under follow-up for asymptomatic COVID-19 and 74 healthy volunteers (mean age 50.71±6.02 years) were enrolled in the study. Heart rate, QRS duration, QT distance, T-wave morphology (Tp-e interval), Tp-e/QT ratio, and index of cardio-electrophysiological balance (iCEB) were analyzed and compared to both groups.
Results: The heart rate was higher, and the QT interval was shorter on ECG in the COVID-19 group. QTc interval, Tp-e intervals, and Tp-e/QT ratio were not different between groups. Furthermore, iCEB and iCEB-c values were not different between groups. A significant positive but weak correlation was observed between CRP and troponin values in patients with COVID-19. Moreover, there was no correlation between troponin levels and Tp-e/QT ratio and iCEB in patients with COVID-19.
Conclusion: The chronic cardiac effects of the COVID-19 have not been elucidated. Prospective clinical trials with long-term and a high number of patient populations are needed to reveal this. Notably, patients with significantly elevated troponin values should be followed up for long-term development of cardiomyopathy and arrhythmias.
References
- 1. Huang, C., et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020. 395(10223): p. 497-506.
- 2. Sohrabi, C., et al., World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International Journal of Surgery, 2020.
- 3. Wang, D., et al., Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 2020.
- 4. Zhou, P., et al., A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 2020. 579(7798): p. 270-273.
- 5. Jia, H.P., et al., ACE2 receptor expression and severe acute respiratory syndrome coronavirus infection depend on differentiation of human airway epithelia. J Virol, 2005. 79(23): p. 14614-21.
- 6. Zhang, H., et al., Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive care medicine, 2020: p. 1-5.
- 7. Zhou, F., et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 2020.
- 8. Guo, T., et al., Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol, 2020.
- 9. Seecheran, R., et al., Atrial Arrhythmias in a Patient Presenting With Coronavirus Disease-2019 (COVID-19) Infection. J Investig Med High Impact Case Rep, 2020. 8: p. 2324709620925571.
- 10. Kuck, K.H., Arrhythmias and sudden cardiac death in the COVID-19 pandemic. Herz, 2020.
- 11. Straus, S.M., et al., Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol, 2006. 47(2): p. 362-7.
- 12. Hetland, M., et al., A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann Noninvasive Electrocardiol, 2014. 19(4): p. 330-7.
- 13. Lu, H.R., G.X. Yan, and D.J. Gallacher, A new biomarker--index of cardiac electrophysiological balance (iCEB)--plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs). J Pharmacol Toxicol Methods, 2013. 68(2): p. 250-259.
- 14. Robyns, T., et al., Evaluation of index of cardio‐electrophysiological balance (iCEB) as a new biomarker for the identification of patients at increased arrhythmic risk. Annals of Noninvasive Electrocardiology, 2016. 21(3): p. 294-304.
- 15. Shimizu, M., et al., T‐peak to T‐end interval may be a better predictor of high‐risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease, 2002. 25(7): p. 335-339.
- 16. Hevia, J.C., et al., Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. Journal of the American College of Cardiology, 2006. 47(9): p. 1828-1834.
- 17. Shi, S., et al., Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol, 2020.
- 18. Kuipers, S., P.M. Klein Klouwenberg, and O.L. Cremer, Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care, 2014. 18(6): p. 688.
- 19. Oudit, G., et al., SARS‐coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. European journal of clinical investigation, 2009. 39(7): p. 618-625.
- 20. Kochi, A.N., et al., Cardiac and arrhythmic complications in patients with COVID‐19. Journal of Cardiovascular Electrophysiology, 2020.
- 21. Cetin, S., et al., Assessment of Tp-e interval and Tp-e/QT ratio in patients with human immunodeficiency virus. Revista Portuguesa de Cardiologia, 2020.
- 22. Demir, C. and M. Demir, Evaluation of Tp-e interval and Tp-e/QT ratio in patients with chronic hepatitis B. Prague Med Rep, 2013. 114(4): p. 239-45.
- 23. Sivri S. and M. Çelik, Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease. Journal of electrocardiology, 2019. 54: p. 72-75.
- 24. Alsancak Y. and F. Çölkesen, Electrocardiographic Alterations in Patients with Common Variable Immune Deficiency. Istanbul Medical Journal, 2020. 21(2).