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THE EFFECT OF THE PRESENCE OF FRAGMENTED QRS IN THE ECG ON THE LENGTH OF STAY IN INTENSIVE CARE UNIT AND MORTALITY IN INTENSIVE CARE COVID-19 PATIENTS

Yıl 2023, Cilt: 24 Sayı: 2, 201 - 205, 05.04.2023

Göksel Güz

https://doi.org/10.18229/kocatepetip.1027690

Öz

OBJECTIVE: The aim of our study is to examine the electrocardiography (ECG) of SARS-COV2 patients with respiratory failure hospitalized in the intensive care unit of our hospital for the presence of fragmented QRS (f-QRS), and to examine the relationship between the presence of fragmented QRS and mortality, length of stay in the intensive care unit, and other prognostic biochemical tests.
MATERIAL AND METHODS: 122 consecutive SARS-COV2 patients hospitalized in the intensive care unit of our hospital between June 2020 and January 2021 were included in the study. The ECGs of the patients were evaluated for the presence of fragmented QRS. Patients were divided into two groups according to the presence of fragmented QRS. The presence of fragmented QRS was confirmed by two experienced cardiologists. The patients' biochemical values such as D-dimer, ferritin, CRP, hemogram, troponin values, intensive care unit length of stay at intensive care unit and mortality rates were compared between these two groups.
RESULTS: f-QRS was detected in 22% of intensive care patients. The CRP, d-Dimer, Troponin values of the patients in the f-QRS group were significantly higher than the covid group without f-QRS. While mortality was 38% in the F-QRS group, it was 22% in the other group (p<0.001). The incidence of f-QRS is high in SARS-COV2 patients.
CONCLUSIONS: Presence of f-QRS in ECG may predict cardiovascular events and mortality in SARS-COV2 patients.

Anahtar Kelimeler

COVID-19 virus Intensive care Electrocardiography Prognosis

Kaynakça

  • 1. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:271–80.
  • 2. Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020;141:1648–55.
  • 3. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497–506.
  • 4. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm in COVID-19. J Infect. 2020;80:607–13.
  • 5. Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;251(3):228-48.
  • 6. Nishiga M, Wang DW, Han Y,et al. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17(9):543-58.
  • 7. Sawalha K, Abozenah M, Kadado AJ, et al. Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome. Cardiovasc Revasc Med. 2021;23:107-13.
  • 8. Ryabykina GV. ECG changes in COVID-19. Kardiologiia. 2020:17;60(8):16-22.
  • 9. Haseeb S, Gul EE, Çinier G, et al. International Society of Electrocardiology Young Community (ISE-YC). Value of electrocardiography in coronavirus disease 2019 (COVID-19). J Electrocardiol. 2020;62:39-45.
  • 10. Michael MA, El Masry H, Khan BR, Das MK, Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis. 2007;50(3):198–208.
  • 11. Pietrasik G, Goldenberg I, Zdzienicka, et al. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardiol. 2007;100(4):583–6.
  • 12. Das M.K, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007;4(11):1385–92.
  • 13. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802–10.
  • 14. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5:1–6.
  • 15. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm' in COVID-19. J Infect. 2020;80:607–13.
  • 16. Guo J, Huang Z, Lv J. Coronavirus disease 2019 (COVID-19) and cardiovascular disease: a viewpoint on the potential influence of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on onset and severity of severe acute respiratory syndrome coronavirus 2 infection. J Am Heart Assoc. 2020;9:016219.
  • 17. McCullough S.A, Goyal P, Krishnan U, et al. Electrocardiographic findings in COVID-19: insights on mortality and underlying myocardial processes. J Card Fail. 2020;26(7):626-632.
  • 18. Lorgis L, Jourda F, Hachet O, RICO Survey Working Group. Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction. Heart Lung. 2013;42(5):326-31.
  • 19. Vandenberk B, Robyns T, Goovaerts G, et al. Inter- and intra-observer variability of visual fragmented QRS scoring in ischemic and non-ischemic cardiomyopathy. J Electrocardiol. 2018;51(3):549-54.
  • 20. Nikoo M, Jamali Z, Razeghian-Jahromi I,et al. Fragmented QRS as an early predictor of left ventricular systolic dysfunction in healthy individuals: a nested case-control study in the era of speckle tracking echocardiography. Cardiovasc Ultrasound. 2020;18(1):1–6.
  • 21. Jellis C, Martin J, Narula J, Marwick TH. Assessment of nonischemic myocardial fibrosis. J Am Coll Cardiol. 20106;56(2):89-97

YOĞUN BAKIM COVID-19 HASTALARINDA EKG'DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ

Yıl 2023, Cilt: 24 Sayı: 2, 201 - 205, 05.04.2023

Göksel Güz

https://doi.org/10.18229/kocatepetip.1027690

Öz

AMAÇ: Çalışmamızın amacı hastanemiz yoğun bakım ünitesinde, solunum yetersizliği nedeniyle yatan SARS-COV2 hastalarının elektrokardiyografisinin (EKG) fragmente QRS (f-QRS) varlığı açısından incelenmesi, f-QRS varlığının mortalite, yoğun bakım yatış süresi ve diğer prognostik biyokimyasal tetkikler ile ilişkisini incelemektir.
GEREÇ VE YÖNTEM: Hastanemiz yoğun bakım ünitesinde Haziran 2020 - Ocak 2021 tarihleri arasında yatan 122 ardışık SARS-COV2 hastası çalışmaya dahil edildi. Hastaların EKG’si f-QRS varlığı açısından değerlendirildi. F-QRS varlığına göre hastalar iki gruba ayrıldı. F-QRS varlığı iki deneyimli kardiyolog tarafından teyit edildi. Hastaların biyokimyasal değerlerinden D-dimer, ferritin, CRP, hemogram, troponin değerleri, yoğun bakım yatış süresi, mortalite oranları bu iki grup arasında karşılaştırıldı.
BULGULAR: Yoğun bakım hastalarının %22’sinde f-QRS saptandı. F-QRS grubundaki hastaların CRP, d-Dimer, Troponin değerleri, f-QRS görülmeyen covid grubuna göre anlamlı yüksek idi. F-QRS grubunda mortalite % 38 iken, diğer grupta mortalite % 22 idi (p<0.001). SARS-COV2 hastalarında f-QRS görülme oranı yüksektir.
SONUÇ: SARS-COV2 hastalarında EKG’de f-QRS varlığı kardiyovasküler olayları ve mortaliteyi öngörebilir

Anahtar Kelimeler

COVID-19 virüs Yoğun bakım Elektrokardiyografi Prognoz

Kaynakça

  • 1. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:271–80.
  • 2. Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020;141:1648–55.
  • 3. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497–506.
  • 4. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm in COVID-19. J Infect. 2020;80:607–13.
  • 5. Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;251(3):228-48.
  • 6. Nishiga M, Wang DW, Han Y,et al. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17(9):543-58.
  • 7. Sawalha K, Abozenah M, Kadado AJ, et al. Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome. Cardiovasc Revasc Med. 2021;23:107-13.
  • 8. Ryabykina GV. ECG changes in COVID-19. Kardiologiia. 2020:17;60(8):16-22.
  • 9. Haseeb S, Gul EE, Çinier G, et al. International Society of Electrocardiology Young Community (ISE-YC). Value of electrocardiography in coronavirus disease 2019 (COVID-19). J Electrocardiol. 2020;62:39-45.
  • 10. Michael MA, El Masry H, Khan BR, Das MK, Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis. 2007;50(3):198–208.
  • 11. Pietrasik G, Goldenberg I, Zdzienicka, et al. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardiol. 2007;100(4):583–6.
  • 12. Das M.K, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007;4(11):1385–92.
  • 13. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802–10.
  • 14. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5:1–6.
  • 15. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm' in COVID-19. J Infect. 2020;80:607–13.
  • 16. Guo J, Huang Z, Lv J. Coronavirus disease 2019 (COVID-19) and cardiovascular disease: a viewpoint on the potential influence of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on onset and severity of severe acute respiratory syndrome coronavirus 2 infection. J Am Heart Assoc. 2020;9:016219.
  • 17. McCullough S.A, Goyal P, Krishnan U, et al. Electrocardiographic findings in COVID-19: insights on mortality and underlying myocardial processes. J Card Fail. 2020;26(7):626-632.
  • 18. Lorgis L, Jourda F, Hachet O, RICO Survey Working Group. Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction. Heart Lung. 2013;42(5):326-31.
  • 19. Vandenberk B, Robyns T, Goovaerts G, et al. Inter- and intra-observer variability of visual fragmented QRS scoring in ischemic and non-ischemic cardiomyopathy. J Electrocardiol. 2018;51(3):549-54.
  • 20. Nikoo M, Jamali Z, Razeghian-Jahromi I,et al. Fragmented QRS as an early predictor of left ventricular systolic dysfunction in healthy individuals: a nested case-control study in the era of speckle tracking echocardiography. Cardiovasc Ultrasound. 2020;18(1):1–6.
  • 21. Jellis C, Martin J, Narula J, Marwick TH. Assessment of nonischemic myocardial fibrosis. J Am Coll Cardiol. 20106;56(2):89-97
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler-Araştırma Yazıları
Yazarlar

Göksel Güz

Yayımlanma Tarihi 5 Nisan 2023
Kabul Tarihi 1 Temmuz 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 24 Sayı: 2

Kaynak Göster

APA Güz, G. (2023). YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ. Kocatepe Tıp Dergisi, 24(2), 201-205. https://doi.org/10.18229/kocatepetip.1027690
AMA Güz G. YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ. KTD. Nisan 2023;24(2):201-205. doi:10.18229/kocatepetip.1027690
Chicago Güz, Göksel. “YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ”. Kocatepe Tıp Dergisi 24, sy. 2 (Nisan 2023): 201-5. https://doi.org/10.18229/kocatepetip.1027690.
EndNote Güz G (01 Nisan 2023) YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ. Kocatepe Tıp Dergisi 24 2 201–205.
IEEE G. Güz, “YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ”, KTD, c. 24, sy. 2, ss. 201–205, 2023, doi: 10.18229/kocatepetip.1027690.
ISNAD Güz, Göksel. “YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ”. Kocatepe Tıp Dergisi 24/2 (Nisan 2023), 201-205. https://doi.org/10.18229/kocatepetip.1027690.
JAMA Güz G. YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ. KTD. 2023;24:201–205.
MLA Güz, Göksel. “YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ”. Kocatepe Tıp Dergisi, c. 24, sy. 2, 2023, ss. 201-5, doi:10.18229/kocatepetip.1027690.
Vancouver Güz G. YOĞUN BAKIM COVID-19 HASTALARINDA EKG’DE FRAGMENTE QRS VARLIĞININ YOĞUN BAKIM YATIŞ SÜRESİ VE MORTALİTEYE ETKİSİ. KTD. 2023;24(2):201-5.
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