Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study.
Samat, Azlan Helmy Abd Cassar, Mark P Akhtar, Abid M McCracken, Celeste Ashkir, Zakariye M Mills, Rebecca Moss, Alastair J Finnigan, Lucy E M Lewandowski, Adam J Mahmod, Masliza
Samat, Azlan Helmy Abd
Cassar, Mark P
Akhtar, Abid M
McCracken, Celeste
Ashkir, Zakariye M
Mills, Rebecca
Moss, Alastair J
Finnigan, Lucy E M
Lewandowski, Adam J
Mahmod, Masliza
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2024-08-08
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Abstract
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.
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Samat AHA, Cassar MP, Akhtar AM, McCracken C, Ashkir ZM, Mills R, Moss AJ, Finnigan LEM, Lewandowski AJ, Mahmod M, Ogbole GI, Tunnicliffe EM, Lukaschuk E, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Singapuri A, Manisty C, O'Regan DP, Weir-McCall JR, Steeds RP, Llm KP, Cuthbertson DJ, Kemp GJ, Horsley A, Miller CA, O'Brien C, Chiribiri A, Francis ST, Chalmers JD, Plein S, Poener AM, Wild JM, Treibel TA, Marks M, Toshner M, Wain LV, Evans RA, Brightling CE, Neubauer S, McCann GP, Raman B; PHOSP-COVID Collaborative group. Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study. Int J Cardiol. 2024 Nov 15;415:132415. doi: 10.1016/j.ijcard.2024.132415. Epub 2024 Aug 8.
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