Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device.

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiology Research Pub Date : 2023-02-01 DOI:10.14740/cr1458

Alexander Edo Tondas, Dian Andina Munawar, Ilaria Marcantoni, Iche Andriyani Liberty, Rido Mulawarman, Muhammad Hadi, Monica Trifitriana, Taufik Indrajaya, Muhammad Yamin, Irfannuddin Irfannuddin, Laura Burattini

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Abstract

Background: Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology.

Methods: Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor^® Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method.

Results: A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R² = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33).

Conclusions: Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.

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t波交替是COVID-19患者复极异常的标志吗?便携式心电图仪的潜力研究。

背景:心律失常与2019冠状病毒病(COVID-19)患者预后不良显著相关。微伏t波交替(TWA)可以自动量化，被认为是复极化异质性的代表，与各种心血管疾病的心律失常有关。本研究旨在探讨微伏TWA与COVID-19病理的相关性。方法:采用Alivecor®Kardiamobile 6L™便携式心电图仪对默罕默德胡辛总医院疑似COVID-19患者进行连续评估。COVID-19重症患者或不能配合主动心电图自记者排除在研究之外。采用增强自适应匹配滤波(EAMF)方法对TWA进行检测，并对TWA的幅值进行量化。结果:共纳入175例患者，其中新冠肺炎患者(PCR阳性组)114例，非新冠肺炎患者(PCR阴性组)61例。pcr阳性组按COVID-19病理严重程度再分为轻、中度严重亚组。两组患者入院时基线TWA水平相似(42.47±26.52µV vs. 44.72±38.21µV)，但pcr阳性患者出院时TWA水平高于pcr阴性组(53.45±34.42µV vs. 25.15±17.64µV, P = 0.03)。校正其他混杂变量后，pcr阳性结果与TWA值相关性显著(R2 = 0.081, P = 0.030)。入院时(44.29±27.14µV vs. 36.75±24.46µV, P = 0.34)和出院时(49.47±33.62µV vs. 61.09±35.99µV, P = 0.33)两组患者的TWA水平无显著差异。结论:pcr阳性患者出院时随访心电图可观察到较高的TWA值。

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来源期刊

Cardiology Research CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.50

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0.00%

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期刊介绍： Cardiology Research is an open access, peer-reviewed, international journal. All submissions relating to basic research and clinical practice of cardiology and cardiovascular medicine are in this journal''s scope. This journal focuses on publishing original research and observations in all cardiovascular medicine aspects. Manuscript types include original article, review, case report, short communication, book review, letter to the editor.