T-wave inversion as a manifestation of COVID-19 infection: a case series.

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2020 Dec

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Cardiac involvement with COVID-19 infection has become evident by elevated troponin, cardiac arrhythmias, ST segment elevation, myocarditis, fulminant heart failure, and sudden cardiac death. We aimed to describe the association of COVID-19 and T-wave inversion (TWI) in a large case series. We conducted an observational, retrospective study of confirmed COVID-19 cases with at least one electrocardiogram (ECG) in a large hospital in New York City (March 23, 2020-April 23, 2020). Patients with new TWI or pseudonormalization were further analyzed. Mortality and the need for invasive mechanical ventilation were the main outcomes. A total of 3225 patients were screened; 195 (6%) were selected for further analysis: 181 with TWI and 14 with T-wave pseudonormalization. Mean age was 66 ± 7 years; 51% were male. TWI were more commonly noted in the lateral (71%), followed by anterior (64%), inferior (57%), and septal (26%) leads. A total of 44 patients (23%) had elevated troponin. A total of 50 patients died (26%). Mortality rates of 35%, and 52% were observed in patients with diffuse TWI, and elevated troponin, respectively. Mortality rate of 80% was observed in patients with both elevated troponin and diffuse TWI. Additionally, 30% of the entire cohort and 58% of patients with elevated troponin required invasive mechanical ventilation. Our study demonstrates that new TWI is a relatively common finding in COVID-19 patients. Importantly, our findings suggest that new TWI or T-wave pseudonormalization, particularly with elevated troponin, was associated with higher rates of mechanical ventilation and in-hospital mortality.

Citation

Jorge Romero, Isabella Alviz, Michael Parides, Juan Carlos Diaz, David Briceno, Mohamed Gabr, Maria Gamero, Kavisha Patel, Eric D Braunstein, Sutopa Purkayastha, Dalvert Polanco, Carolina R Valencia, Domenico Della Rocca, Alejandro Velasco, Ruike Yang, Nicola Tarantino, Xiao-Dong Zhang, Sanghamitra Mohanty, Juan Bello, Andrea Natale, Ulrich P Jorde, Mario Garcia, Luigi Di Biase. T-wave inversion as a manifestation of COVID-19 infection: a case series. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 2020 Dec;59(3):485-493