ECG pathology and its association with death in critically ill COVID-19 patients, a cohort study

Background We investigated the prevalence of ECG abnormalities and their association with mortality, organ dysfunction and cardiac biomarkers in a cohort of COVID-19 patients admitted to the intensive care unit (ICU). Methods This cohort study included patients with COVID-19 admitted to the ICU of a tertiary hospital in Sweden. ECG, clinical data and laboratory findings during ICU stay were extracted from medical records and ECGs obtained near ICU admission were reviewed by two independent physicians. Results Eighty patients had an acceptable ECG near ICU-admission. In the entire cohort 30-day mortality was 28%. Compared to patients with normal ECG, among whom 30-day mortality was 16%, patients with ECG fulfilling criteria for prior myocardial infarction had higher mortality, 63%, odds ratio (OR) 9.61 (95% confidence interval (CI) 2.02–55.6) adjusted for Simplified Acute Physiology Score 3 and patients with ST-T abnormalities had 50% mortality and OR 6.05 (95% CI 1.82–21.3) in univariable analysis. Both prior myocardial infarction pattern and ST-T pathology were associated with need for vasoactive treatment and higher peak plasma levels of troponin-I, NT-pro-BNP (N-terminal pro-Brain Natriuretic Peptide), and lactate during ICU stay compared to patients with normal ECG. Conclusion ECG with prior myocardial infarction pattern or acute ST-T pathology at ICU admission is associated with death, need for vasoactive treatment and higher levels of biomarkers of cardiac damage and strain in severely ill COVID-19 patients, and should alert clinicians to a poor prognosis.

Symptomatic hypotensive episodes in patients with hypertension. Relationship with blood pressure self-monitoring parameters

Aim. To study the relationship between symptomatic hypotensive episodes (SHEs) and parameters of self-monitoring of blood pressure (SMPB) in patients with hypertension (HTN).Material and methods. A total of 77 patients from 40 to 76 years old with HTN were examined. To identify SHEs, an original questionnaire was used. Patients underwent SMBP in the morning and evening, as well as recorded SHE in the diary. The self-monitoring period lasted 4 weeks. Patients without prior myocardial infarction and/or stroke are conventionally called “uncomplicated” HTN, while with cardiovascular events in history — “complicated” HTN.Results. According to the questionnaire, 48 (62,3%) patients noted SHEs. Uncomplicated HTN was recorded in 19 (51,4%) participants, while complicated one — in 29 (72,5%) (p=0,05). Blood pressure during SHEs was on average higher in patients with complicated HTN than in uncomplicated HTN (103/60 vs 95/60 mm Hg (p=0,05)). With a combination of uncomplicated HTN and SEG, mean systolic blood pressure (SBP) (125,9±10,5 vs 137,9±8,2 mm Hg), evening SBP (125,3±8,1vs 133,3±10,4 mm Hg), maximum SBP (149,8±11,8 vs 161,7±12,1 mm Hg) in the morning, as well as minimum SBP in the evening (101,8±10,8 vs 113,7±9,7 mm Hg) were lower than in patients without SHEs (p<0,05).In complicated HTN, an opposite relationship was observed: patients with SHEs had higher mean SBP (133,49±12,4 vs 118,93±15,3 mm Hg), maximum SBP (162,8±11,6 vs 141,7±12,0 mm Hg), and diastolic blood pressure (DBP) (91,5±5,6 vs 83,5±8,8 mm Hg) in the morning (p<0,05), as well as higher variability of morning (11,8±2,1 vs 8,2±2,7 mm Hg) and evening SBP (11,9±4,2 vs 8,6±3,2 mm Hg) compared with patients without SHEs (p<0,05). There were no significant differences in antihypertensive therapy.Conclusion. More than half of patients with hypertension report SHEs. SHEs in patients without prior myocardial infarction and/or stroke were characterized by lower blood pressure level than in subjects with prior cardiovascular events. Among patients with SHEs without cardiovascular events, the values of morning, evening, and maximum SBP in the morning are lower than in patients without SHEs. In patients with complicated HTN and SHEs, the opposite trend was observed: higher SBP and DBP in the morning, as well as greater variability of morning and evening SBP, in comparison with those without SHEs. These patterns cannot be explained by the antihypertensive drugs taken.

ECG with Prior Myocardial Infarction Pattern or acute ST-T Pathology is Associated with Death in Critically Ill COVID-19 Patients

Background: We investigated the prevalence of ECG abnormalities and their association with mortality, organ dysfunction and cardiac biomarkers in a cohort of COVID-19 patients admitted to the intensive care unit (ICU).Methods: This cohort study included patients with COVID-19 admitted to the ICU of a tertiary hospital in Sweden. ECG, clinical data and laboratory findings during ICU stay were extracted from medical records and ECGs obtained near ICU admission were reviewed by two independent physicians. Results: Eighty patients had an acceptable ECG near ICU-admission. In the entire cohort 30-day mortality was 28%. Compared to patients with normal ECG, among whom 30-day mortality was 16%, patients with ECG fulfilling criteria for prior myocardial infarction had higher mortality, 63%, odds ratio (OR) 9.61 (95% confidence interval (CI) 2.02-55.6) adjusted for Simplified Acute Physiology Score 3 and patients with ST-T abnormalities had 50% mortality and OR 6.05 (95% CI 1.82-21.3) in univariate analysis. Both prior myocardial infarction pattern and ST-T pathology were associated with need for vasoactive treatment and higher peak plasma levels of troponin-I, NT-pro-BNP (N-terminal pro-Brain Natriuretic Peptide), and lactate during ICU stay compared to patients with normal ECG. Conclusion: ECG with prior myocardial infarction pattern or acute ST-T pathology at ICU admission is associated with death, need for vasoactive treatment and higher levels of biomarkers of cardiac damage and strain in severely ill COVID-19 patients, and should alert clinicians to a poor prognosis.Trial registration: ClinicalTrials ID: NCT04316884. Registered 20 March 2020, https://clinicaltrials.gov/ct2/show/NCT04316884.