TY - JOUR
T1 - Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients
T2 - a prospective multicenter study
AU - Samat, Azlan Helmy Abd
AU - Cassar, Mark P.
AU - Akhtar, Abid M.
AU - McCracken, Celeste
AU - Ashkir, Zakariye M.
AU - Mills, Rebecca
AU - Moss, Alastair J.
AU - Finnigan, Lucy E.M.
AU - Lewandowski, Adam J.
AU - Mahmod, Masliza
AU - Ogbole, Godwin I.
AU - Tunnicliffe, Elizabeth M.
AU - Lukaschuk, Elena
AU - Piechnik, Stefan K.
AU - Ferreira, Vanessa M.
AU - Nikolaidou, Chrysovalantou
AU - Rahman, Najib M.
AU - Ho, Ling Pei
AU - Harris, Victoria C.
AU - Singapuri, Amisha
AU - Manisty, Charlotte
AU - O'Regan, Declan P.
AU - Weir-McCall, Jonathan R.
AU - Steeds, Richard P.
AU - Poinasamy, Krisnah
AU - Cuthbertson, Dan J.
AU - Kemp, Graham J.
AU - Horsley, Alexander
AU - Miller, Christopher A.
AU - O'Brien, Caitlin
AU - Chiribiri, Amedeo
AU - Francis, Susan T.
AU - Chalmers, James D.
AU - Plein, Sven
AU - Poener, Ana Maria
AU - Wild, James M.
AU - Treibel, Thomas A.
AU - Marks, Michael
AU - Toshner, Mark
AU - Wain, Louise V.
AU - Evans, Rachael A.
AU - Brightling, Christopher E.
AU - Neubauer, Stefan
AU - McCann, Gerry P.
AU - Raman, Betty
AU - George, J
N1 - Publisher Copyright:
© 2024 The Authors.
PY - 2024/11/15
Y1 - 2024/11/15
N2 - Background The role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients. 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.
AB - Background The role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients. 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.
KW - CMR
KW - ECG
KW - Electrocardiogram
KW - Repolarisation
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85201752342&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2024.132415
DO - 10.1016/j.ijcard.2024.132415
M3 - Article
C2 - 39127146
AN - SCOPUS:85201752342
SN - 0167-5273
VL - 415
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132415
ER -