Electrocardiographic Risk Stratification in COVID-19 Patients

  1. Ehud Chorin
  2. Matthew Dai
  3. Edward Kogan
  4. Lalit Wadhwani
  5. Eric Shulman
  6. Charles Nadeau-Routhier
  7. Robert Knotts
  8. Roi Bar-Cohen
  9. Chirag Barbhaiya
  10. Anthony Aizer
  11. Douglas Holmes
  12. Scott Bernstein
  13. Michael Spinelli
  14. David Park
  15. Larry Chinitz
  16. Lior Jankelson

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Abstract

Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality.

Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion.

Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05–1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality.

Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.

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  1. Version published to 10.3389/fcvm.2021.636073
  2. ScreenIT

    SciScore for 10.1101/2020.11.12.20230565: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was reviewed and approved by the NYU Institutional Review Board and Quality Improvement initiative in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, with a waiver of informed consent.
    Consent: The study was reviewed and approved by the NYU Institutional Review Board and Quality Improvement initiative in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, with a waiver of informed consent.
    Randomizationnot detected.
    BlindingECGs were reviewed and interpreted by five seniors cardiologists who were blinded to the clinical status of the patients.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Troponin I concentrations were assessed via the Abbott Architect method (Abbott, Abbott Park, Illinois) wherein the 99th percentile for a normal population is 0.05 ng/mL.
    Abbott
    suggested: (Abbott, RRID:SCR_010477)
    Statistical analysis: Statistical analysis was performed using IBM SPSS Statistics 26, and figures were constructed using GraphPad Prism 8.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our study has several limitations. This is an observational, retrospective study. Because of its retrospective nature, the study is subject to selection bias, and its results imply association, not cause and effect. Relatively short follow-up time after was available.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.11.12.20230565v1 on medRxiv