Comparing of the First Electrocardiographic Variables in Patients with Newly Diagnosed COVID-19 with Healthy Men Volunteer: A Systematic Review and Meta-Analysis
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Abstract
Background: We aimed to report the findings of the first Electrocardiography (ECG), before therapy initiation and receiving medication in COVID-19 patients, and to compare them with the ECG findings of healthy men.
Methods: A comprehensive and regular search was performed through the keywords (“Electrocardiographic” OR “ECG” OR; ‘‘COVID-19’’ OR ‘‘Coronavirus Disease 2019’’) without time and language restrictions in the Web of Science, Scopus, ProQuest, Cochrane Library, Science Direct, Medline, PubMed and Google Scholar. After evaluating the quality and reviewing the biases, 27 studies were finally enrolled.
Results: In 27 studies with a total number of 3994 COVID-19 patients, and mean age of 62.7 yr, 1993 subjects were male. The most common type of arrhythmia in them, especially in severe and critical cases, was 7% based on 10 studies (Atrial Fibrillation); while in 7 studies, QTc interval prolong (≥ 460 msec) was 15% and in 5 studies, QTc interval prolong (≥ 500 msec) was 18%. In COVID-19 patients at the time of admission and healthy men, HR (b per / min) was 85, 61.7 and PR interval (msec) was 285.4, 156 and QRS duration (msec) was 95, 94.3 and QT (msec) was 380. 384.1 and QTc (msec) (Bazett's formula) was 437, 387.1, respectively. In most cases, the variables were higher for COVID-19 patients.
Conclusion: ECG abnormalities at the time of admission and prior to the initiation of medication that cause arrhythmic may have a clinically substantial effect on the course of the disease and confirm the effect of COVID-19 on increased cardiovascular risk in long-term.
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21. Hafiz M, Icksan AG, Harlivasari AD, et al (2020). Clinical, Radiological Features and Outcome of COVID-19 patients in a Secondary Hospital in Jakarta, Indonesia. J Infect Dev Ctries, 14(7):750-757.
22. Voisin OMD, le Lorc'h EMD, Mahé AMD, et al (2020). Acute QT Interval Modifications During Hydroxychloroquine-Azithromycin Treatment in the Context of COVID-19 Infection. Mayo Clin Proc, 95(8):1696-1700.
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24. Borba MGS, Val FFA, Sampaio VS, et al (2020). Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial. JAMA Netw Open, 3(4):e208857.
25. Bun SS, Taghji P, Courjon J, et al (2020). QT Interval Prolongation Under Hydroxychloroquine/Azithromycin Association for Inpatients With SARS-CoV-2 Lower Respiratory Tract Infection. Clin Pharmacol Ther, 108(5):1090-1097.
26. Jain S, Workman V, Ganeshan R, Obasare ER, et al (2020). Enhanced electrocardiographic monitoring of patients with Coronavirus Disease 2019. Heart Rhythm, 17(9): 1417–1422.
27. Bakhshaliyev N, Uluganyan M, Enhos A, et al (2020). The effect of 5-day course of hydroxychloroquine and azithromycin combination on QT interval in non-ICU COVID19(+) patients. J Electrocardiol, 62:59-64.
28. Ozturk F, Karaduman M, Coldur R, 2020. Interpretation of arrhythmogenic effects of COVID-19 disease through ECG. Aging Male, 1-4.
29. Cipriani A, Zorzi A, Ceccato D, et al (2020). Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin. International Journal of Cardiology, 316: 280–284.
30. Chorin E, Dai M, Shulman E, et al (2020). The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med, 26(6):808-809.
31. Chorin E, Wadhwani L, Magnani S, et al (2020). QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. Heart Rhythm, 17(9): 1425–1433.
32. Maraj I, Hummel JP, Taoutel R, et al (2020). Incidence and Determinants of QT Interval Prolongation in COVID‐19 Patients Treated with Hydroxychloroquine and Azithromycin. J Cardiovasc Electrophysiol, 31(8):1904-1907.
33. Yu CM, Wong RSM, Wu EB, et al (2006). Cardiovascular complications of severe acute respiratory syndrome. Postgrad Med J, 82(964): 140–144.
34. Friedman DJ, Wang N, Meigs JB, et al (2014). Pericardial fat is associated with atrial conduction: the Framingham Heart Study. J Am Heart Assoc, 3(2):e000477.
35. Wu C-I, Postema PG, Arbelo E, et al (2020). SARS-CoV-2, COVID-19 and inherited arrhythmia syndromes. Heart Rhythm, 17:1456-1462.
36. Yalta T, Yalta K (2018). Systemic inflammation and arrhythmogenesis: a review of mechanistic and clinical perspectives. Angiology, 69(4):288-296.
2. Angeli F, Spanevello A, De Ponti R, et al (2020). Electrocardiographic features of patients with COVID-19 pneumonia. Eur J Intern Med, 78:101-106.
3. McCullough SA, Goyal P, Krishnan U, et al (2020). Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes. J Card Fail, 26(7):626-632.
4. Moher D, Shamseer L, Clarke M, et al (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ, 349:g7647.
5. Harris RI, Steare SE (2006). A meta-analysis of ECG data from healthy male volunteers: diurnal and intra-subject variability, and implications for planning ECG assessments and statistical analysis in clinical pharmacology studies. Eur J Clin Pharmacol, 62(11):893-903.
6. Moola S, Munn Z, Tufanaru C, et al (2020). Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI.
7. Higgins JP, Thompson SG (2002). Quantifying heterogeneity in a meta‐analysis. Stat Med, 21(11):1539-58.
8. Deng Q, Hu B, Zhang Y, et al (2020). Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol, 311:116-121.
9. Chen Q, Xu L, Dai Y, et al (2020). Cardiovascular manifestations in severe and critical patients with COVID ‐19. Clin Cardiol, 43:796-802.
10. Strik M, Caillol T, Ramirez FD, et al (2020). Validating QT-Interval Measurement Using the Apple Watch ECG to Enable Remote Monitoring During the COVID-19 Pandemic. Circulation, 142(4):416-418.
11. Ramireddy A, Chugh H, Reinier K, et al (2020). Experience With Hydroxychloroquine and Azithromycin in the Coronavirus Disease 2019 Pandemic: Implications for QT Interval Monitoring. J Am Heart Assoc, 9(12):e017144.
12. C Hsia B, Greige N, A Quiroz J, et al (2020). QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin. J Interv Card Electrophysiol, 1-9.
13. Pishgahi M, Yousefifard M, Safari S, Ghorbanpouryami F (2020). Electrocardiographic Findings of COVID-19 Patients and Their Correlation with Outcome; a Prospective Cohort Study. Advanced Journal of Emergency Medicine, In press.
14. Rath D, Petersen-Uribe Á, Avdiu A, et al (2020). Impaired cardiac function is associated with mortality in patients with acute COVID-19 infection. Clin Res Cardiol, 109(12):1491-1499.
15. Saleh M, Gabriels J, Chang D, et al (2020). Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection. Circulation: Arrhythmia and Electrophysiology,496-504.
16. Gayam V, Konala VM, Naramala S, et al (2020). Presenting characteristics, comorbidities, and outcomes of patients coinfected with COVID-19 and Mycoplasma pneumoniae in the USA. J Med Virol, 2181-2187.
17. van den Broek MPH, Möhlmann JE, Abeln BGS, et al (2020). Chloroquine-induced QTc prolongation in COVID-19 patients. Neth Heart J, 28(7-8): 406–409.
18. Moschini L, Loffi M, Regazzoni V, et al (2020). Effects on QT interval of hydroxychloroquine associated with ritonavir/darunavir or azithromycin in patients with SARS-CoV-2 infection. Heart Vessels:1-6.
19. Sinkeler FS, Berger FA, Muntinga HJ, Jansen MMPM (2020). The risk of QTc-interval prolongation in COVID-19 patients treated with chloroquine. Neth Heart J, 28(7-8): 418–423.
20. Maeda T, Obata R, Rizk D, Kuno T (2020). The Association of Interleukin‐6 value, Interleukin inhibitors and Outcomes of Patients with COVID‐19 in New York City. J Med Virol, doi: 10.1002/jmv.26365.
21. Hafiz M, Icksan AG, Harlivasari AD, et al (2020). Clinical, Radiological Features and Outcome of COVID-19 patients in a Secondary Hospital in Jakarta, Indonesia. J Infect Dev Ctries, 14(7):750-757.
22. Voisin OMD, le Lorc'h EMD, Mahé AMD, et al (2020). Acute QT Interval Modifications During Hydroxychloroquine-Azithromycin Treatment in the Context of COVID-19 Infection. Mayo Clin Proc, 95(8):1696-1700.
23. Yenerçağ M, Arslan U, Doğduş M, et al (2020). Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19. J Electrocardiol, 62:5-9.
24. Borba MGS, Val FFA, Sampaio VS, et al (2020). Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial. JAMA Netw Open, 3(4):e208857.
25. Bun SS, Taghji P, Courjon J, et al (2020). QT Interval Prolongation Under Hydroxychloroquine/Azithromycin Association for Inpatients With SARS-CoV-2 Lower Respiratory Tract Infection. Clin Pharmacol Ther, 108(5):1090-1097.
26. Jain S, Workman V, Ganeshan R, Obasare ER, et al (2020). Enhanced electrocardiographic monitoring of patients with Coronavirus Disease 2019. Heart Rhythm, 17(9): 1417–1422.
27. Bakhshaliyev N, Uluganyan M, Enhos A, et al (2020). The effect of 5-day course of hydroxychloroquine and azithromycin combination on QT interval in non-ICU COVID19(+) patients. J Electrocardiol, 62:59-64.
28. Ozturk F, Karaduman M, Coldur R, 2020. Interpretation of arrhythmogenic effects of COVID-19 disease through ECG. Aging Male, 1-4.
29. Cipriani A, Zorzi A, Ceccato D, et al (2020). Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin. International Journal of Cardiology, 316: 280–284.
30. Chorin E, Dai M, Shulman E, et al (2020). The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med, 26(6):808-809.
31. Chorin E, Wadhwani L, Magnani S, et al (2020). QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. Heart Rhythm, 17(9): 1425–1433.
32. Maraj I, Hummel JP, Taoutel R, et al (2020). Incidence and Determinants of QT Interval Prolongation in COVID‐19 Patients Treated with Hydroxychloroquine and Azithromycin. J Cardiovasc Electrophysiol, 31(8):1904-1907.
33. Yu CM, Wong RSM, Wu EB, et al (2006). Cardiovascular complications of severe acute respiratory syndrome. Postgrad Med J, 82(964): 140–144.
34. Friedman DJ, Wang N, Meigs JB, et al (2014). Pericardial fat is associated with atrial conduction: the Framingham Heart Study. J Am Heart Assoc, 3(2):e000477.
35. Wu C-I, Postema PG, Arbelo E, et al (2020). SARS-CoV-2, COVID-19 and inherited arrhythmia syndromes. Heart Rhythm, 17:1456-1462.
36. Yalta T, Yalta K (2018). Systemic inflammation and arrhythmogenesis: a review of mechanistic and clinical perspectives. Angiology, 69(4):288-296.
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| Issue | Vol 50 No 1 (2021) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v50i1.5071 | |
| Keywords | ||
| Electrocardiographic COVID-19 Arrhythmia Heart Meta-Analysis | ||
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How to Cite
1.
ARIAN M, VALINEJADI A, VAKILIAN F. Comparing of the First Electrocardiographic Variables in Patients with Newly Diagnosed COVID-19 with Healthy Men Volunteer: A Systematic Review and Meta-Analysis. Iran J Public Health. 2020;50(1):46-57.
