Electrocardiography in Early Diagnosis of Cardiovascular Complications of COVID-19; a Systematic Literature Review
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
Introduction: Many reports have stated that patients admitted for COVID-19 may also suffer from cardiovascular diseases, suggesting cardiovascular involvement in COVID-19. Since there is direct association between electrocardiography (ECG) data and the prognosis of cardiovascular disease, a systematic literature review was performed in the present study to address this association and make a conclusive agreement on the early diagnostic and prognostic values of ECG in patients with COVID-19.
Methods: Electronic databases including PubMed, Scopus, Web of Science, Science Direct, Ovid, Embase, and Google Scholar were searched for “COVID-19” and “ECG” using all their equivalents and similar terms as search words. Afterwards, the records were limited to English articles and irrelevant documents, as well as articles that reported drug-induced cardiac dysfunction or patients with previous history of cardiovascular complications were excluded.
Results: Overall, 31 articles with 2379 patients were found and used for qualitative data extraction. Findings showed that there is a significant association between COVID-19 infection and ECG findings. Also, ST-segment changes, T wave inversions, QT prolongation, and atrial fibrillation were found to be early indicators of cardiac involvement of COVID-19, which were associated with worse outcomes.
Conclusion: It is recommended to use ECG as a valuable diagnostic and prognostic tool for cardiac evaluation of patients with COVID-19.
- COVID-19; Heart Diseases; Heart Injuries; Electrocardiography; Prognosis
How to Cite
Zhu H, Wei L, Niu P. The novel coronavirus outbreak in Wuhan, China. Global Health Research and Policy. 2020;5(1):1-3.
Kang S, Peng W, Zhu Y, Lu S, Zhou M, Lin W, et al. Recent Progress in understanding 2019 novel coronavirus associated with human respiratory disease: detection, mechanism and treatment. International Journal of Antimicrobial Agents. 2020;55(5):105950.
Qian J-Y, Wang B, Liu B-C. Acute kidney injury in the 2019 novel coronavirus disease. Kidney Diseases. 2020;6(5):318-23.
Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, et al. Clinical Features of COVID-19-Related Liver Functional Abnormality. Clin Gastroenterol Hepatol. 2020;18(7):1561-6.
Dorche MS, Huot P, Osherov M, Wen D, Saveriano A, Giacomini P, et al. Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. Journal of the Neurological Sciences. 2020;417:117085.
Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovascular research. 2020;116(10):1666-87.
DeFilippis EM, Reza N, Donald E, Givertz MM, Lindenfeld J, Jessup M. Considerations for Heart Failure Care During the COVID-19 Pandemic. JACC Heart failure. 2020;8(8):681-91.
Ben Gal T, Ben Avraham B, Abu-Hazira M, Frigerio M, Crespo-Leiro MG, Oppelaar AM, et al. The consequences of the COVID-19 pandemic for self-care in patients supported with a left ventricular assist device. European journal of heart failure. 2020;22(6):933-6.
Organization WH. COVID-19 weekly epidemiological update, 17 November 2020. 2020.
Dan S, Pant M, Upadhyay SK. The Case Fatality Rate in COVID-19 Patients With Cardiovascular Disease: Global Health Challenge and Paradigm in the Current Pandemic. Current Pharmacology Reports. 2020:1-10.
Churchill TW, Bertrand PB, Bernard S, Namasivayam M, Churchill J, Crousillat D, et al. Echocardiographic Features of COVID-19 Illness and Association with Cardiac Biomarkers. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2020;33(8):1053-4.
He J, Wu B, Chen Y, Tang J, Liu Q, Zhou S, et al. Characteristic Electrocardiographic Manifestations in Patients With COVID-19. The Canadian journal of cardiology. 2020;36(6):966 e1- e4.
Shi S, Qin M, Cai Y, Liu T, Shen B, Yang F, et al. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019. European heart journal. 2020;41(22):2070-9.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Angeli F, Spanevello A, De Ponti R, Visca D, Marazzato J, Palmiotto G, et al. Electrocardiographic features of patients with COVID-19 pneumonia. European journal of internal medicine. 2020;78:101-6.
McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes. Journal of cardiac failure. 2020;26(7):626-32.
Ozturk F, Karaduman M, Coldur R, Incecik S, Gunes Y, Tuncer M. Interpretation of arrhythmogenic effects of COVID-19 disease through ECG. The aging male : the official journal of the International Society for the Study of the Aging Male. 2020:1-4.
Pavri BB, Kloo J, Farzad D, Riley JM. Behavior of the PR interval with increasing heart rate in patients with COVID-19. Heart rhythm. 2020.
van de Poll SWE, van der Werf C. Two patients with COVID-19 and a fever-induced Brugada-like electrocardiographic pattern. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2020;28(7-8):431-6.
Vidovich MI. Transient Brugada-Like Electrocardiographic Pattern in a Patient With COVID-19. JACC Case reports. 2020;2(9):1245-9.
Vera-Pineda R, Francisco Carrizales-Sepulveda E, Camacho-Ortiz A, Nuzzolo-Shihadeh L, Cruz-Ramos F, Ordaz-Farias A, et al. Echocardiographic Characteristics of Subjects With COVID-19: A Case Series. Cardiology research. 2020;11(4):260-5.
Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. International journal of cardiology. 2020;311:116-21.
Dweck MR, Bularga A, Hahn RT, Bing R, Lee KK, Chapman AR, et al. Global evaluation of echocardiography in patients with COVID-19. European heart journal cardiovascular Imaging. 2020;21(9):949-58.
Kochav SM, Coromilas E, Nalbandian A, Ranard LS, Gupta A, Chung MK, et al. Cardiac Arrhythmias in COVID-19 Infection. Circulation Arrhythmia and electrophysiology. 2020;13(6):e008719.
Amaratunga EA, Corwin DS, Moran L, Snyder R. Bradycardia in Patients With COVID-19: A Calm Before the Storm? Cureus. 2020;12(6):e8599.
Gill GS, Vlacancich R, Mehta N, Chaturvedi M, Papolos A. Spectrum of Cardiac Involvement in COVID-19. Cureus. 2020;12(6):e8638.
Tedeschi D, Rizzi A, Biscaglia S, Tumscitz C. Acute myocardial infarction and large coronary thrombosis in a patient with COVID-19. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2020.
Doyen D, Moceri P, Ducreux D, Dellamonica J. Myocarditis in a patient with COVID-19: a cause of raised troponin and ECG changes. Lancet. 2020;395(10235):1516.
Kim IC, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. European heart journal. 2020;41(19):1859.
Irabien-Ortiz A, Carreras-Mora J, Sionis A, Pamies J, Montiel J, Tauron M. Fulminant myocarditis due to COVID-19. Rev Esp Cardiol (Engl Ed). 2020;73(6):503-4.
Cizgici AY, Zencirkiran Agus H, Yildiz M. COVID-19 myopericarditis: It should be kept in mind in today's conditions. The American journal of emergency medicine. 2020;38(7):1547 e5- e6.
Oberweis ML, Codreanu A, Boehm W, Olivier D, Pierron C, Tsobo C, et al. Pediatric Life-Threatening Coronavirus Disease 2019 With Myocarditis. The Pediatric infectious disease journal. 2020;39(7):e147-e9.
Loghin C, Chauhan S, Lawless SM. Pseudo-Acute Myocardial Infarction in a Young COVID-19 Patient. JACC Case reports. 2020;2(9):1284-8.
Hussain H, Fadel A, Alwaeli H, Guardiola V. Coronavirus (COVID-19) Fulminant Myopericarditis and Acute Respiratory Distress Syndrome (ARDS) in a Middle-Aged Male Patient. Cureus. 2020;12(6):e8808.
Juthani P, Bhojwani R, Gupta N. Coronavirus Disease 2019 (COVID-19) Manifestation as Acute Myocardial Infarction in a Young, Healthy Male. Case reports in infectious diseases. 2020;2020:8864985.
Ong E, Castro-Dominguez Y, Brennan J, Oen-Hsiao J. COVID-19 complicated by ST-segment elevation myocardial infarction in a 29-year-old patient. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2020.
Rehman M, Gondal A, Rehman NU. Atypical Manifestation of COVID-19-Induced Myocarditis. Cureus. 2020;12(6):e8685.
van den Heuvel FMA, Vos JL, Koop Y, van Dijk APJ, Duijnhouwer AL, de Mast Q, et al. Cardiac function in relation to myocardial injury in hospitalised patients with COVID-19. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2020;28(7-8):410-7.
Asif T, Ali Z. Transient ST Segment Elevation in Two Patients with COVID-19 and a Normal Transthoracic Echocardiogram. European journal of case reports in internal medicine. 2020;7(5):001672.
Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020.
Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-Elevation Myocardial Infarction in Patients With COVID-19: Clinical and Angiographic Outcomes. Circulation. 2020;141(25):2113-6.
Trogen B, Gonzalez FJ, Shust GF. COVID-19-Associated Myocarditis in an Adolescent. The Pediatric infectious disease journal. 2020;39(8):e204-e5.
Juusela A, Nazir M, Gimovsky M. Two cases of coronavirus 2019-related cardiomyopathy in pregnancy. American journal of obstetrics & gynecology MFM. 2020;2(2):100113.
Tak‐Sun T, Kin‐Lam T, Loretta YC, Loletta KY, Arthur CW, Kwok‐Keung C, et al. Occult pneumomediastinum in a SARS patient presenting as recurrent chest pain and acute ECG changes mimicking acute coronary syndrome. Respirology (Carlton, Vic). 2004;9(2):271-3.
Yu C, Wong RS, Wu E, Kong S, Wong J, Yip GW, et al. Cardiovascular complications of severe acute respiratory syndrome. Postgraduate Medical Journal. 2006;82(964):140-4.
Bethell DB, Dung NM, Loan HT, Minh LTN, Dung NQ, Day NP, et al. Prognostic value of electrocardiographic monitoring of patients with severe diphtheria. Clinical Infectious Diseases. 1995;20(5):1259-65.
Rojas LZ, Glisic M, Pletsch-Borba L, Echeverría LE, Bramer WM, Bano A, et al. Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis. PLoS Neglected Tropical Diseases. 2018;12(6):e0006567.
Puljiz I, Kuzman I, Markotić A, Turčinov D, Matić M, Makek N. Electrocardiographic changes in patients with haemorrhagic fever with renal syndrome. Scandinavian Journal of Infectious Diseases. 2005;37(8):594-8.
Woolf PK, Lorsung EM, Edwards KS, Li KI, Kanengiser SJ, Ruddy RM, et al. Electrocardiographic findings in children with Lyme disease. Pediatric Emergency Care. 1991;7(6):334-6.
Hsia BC, Greige N, Quiroz JA, Khokhar AS, Daily J, Di Biase L, et al. QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 2020.
Tuncer T, Karaci M, Boga A, Durmaz H, Guven S. QT interval evaluation associated with the use of hydroxychloroquine with combined use of azithromycin among hospitalised children positive for coronavirus disease 2019. Cardiology in the young. 2020:1-4.
Rath D, Petersen-Uribe A, Avdiu A, Witzel K, Jaeger P, Zdanyte M, et al. Impaired cardiac function is associated with mortality in patients with acute COVID-19 infection. Clinical research in cardiology : official journal of the German Cardiac Society. 2020.
Alexander LK, Keene BW, Yount BL, Geratz JD, Small JD, Baric RS. ECG changes after rabbit coronavirus infection. Journal of electrocardiology. 1999;32(1):21-32.
MacIntyre CR, Mahimbo A, Moa AM, Barnes M. Influenza vaccine as a coronary intervention for prevention of myocardial infarction. Heart. 2016;102(24):1953-6.
Pasqualetto MC, Corrado A, Secco E, Graceffa F, Rigo F. Transient Type 1 Brugada Pattern without Ongoing Fever during COVID-19 Pneumonia. European journal of case reports in internal medicine. 2020;7(7):001808.
Kim HN, Lee JH, Park HS, Yang DH, Jang SY, Bae MH, et al. A Case of COVID-19 with Acute Myocardial Infarction and Cardiogenic Shock. Journal of Korean medical science. 2020;35(27):e258.
Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. Jama. 2020.
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