Specific Waveforms on Cardiac Imaging Tests May Predict Worsening Health and Death of Hospitalized COVID-19 Patients

Dynamic changes on scans could prompt more aggressive treatment and monitoring in acute hospital setting

Title: “Prognostic Value of Electrocardiographic QRS Diminution in Patients With COVID-19”

Journal:  Journal of the American College of Cardiology – May 4th print publicationhttps://www.jacc.org/doi/10.1016/j.jacc.2021.02.062

Author: Joshua Lampert, MD, Cardiology Fellow at Mount Sinai Heart

Bottom Line: A dynamic reduction in QRS waveform height on electrocardiograms  (QRS measures electrical activity on the major chambers of the heart or ventricles) can predict worsening health and death in patients hospitalized with COVID-19.  Researchers showed patients with shrinking waveforms/electrical signals died roughly 52 hours after their electrocardiogram (EKG) met LoQRS criteria and important clues were apparent two days before patients died. LoQRS is a set of criteria that describe a shrinkage of the electrical signal on the EKG.   Patients were considered to have LoQRS if any of the criteria were met.

Why this research is important: The EKG is readily accessible, which makes LoQRS a pragmatic tool for frontline healthcare workers to use so they can better assess which COVID-19 patients may get sicker and possibly die. LoQRS captures dynamic changes during the course of illness, which may prompt physicians in an acute hospital setting to reassess how sick the patient may be and potentially give more aggressive therapy.

How study was conducted? Researchers did a retrospective analysis of EKG’s on 140 patients hospitalized with COVID-19 across the Mount Sinai Health System in New York City. Experienced EKG readers manually measured the QRS complexes and applied the changes in waveforms to a set of criteria. Then, they looked for differences in clinical outcomes between the groups that did or did not have LoQRS criteria present.

Conclusions: LoQRS is an independent predictor of mortality in hospitalized patients with COVID-19, captures a dynamic process during the course of illness, and underscores the prognostic utility of a relative reduction in QRS amplitude.

What does this mean for doctors/patients? Doctors in acute hospital settings should look for changes in these wavelengths on EKG’s and can use these scans to help predict which COVID-19 patients may get sicker and die – potentially leading to closer patient observation and escalation of therapy, although more studies are needed to demonstrate that such changes in treatment impact the clinical outcome. 

Researchers: “All frontline providers are capable of detecting this change of wavelength on EKG’s.  We discovered specific clues were apparent two days before hospitalized COVID-19 patients died.  This information can give physicians an opportunity to reassess patients in the acute hospital setting and possibly intensify the treatment plan,” says lead researcher Dr. Joshua Lampert.  "Our study shows LoQRS criteria may have implications in other viral illnesses and cardiac diseases. Further studies should investigate whether escalating therapy when LoQRS is identified can benefit patient outcomes. This study also underscores the importance of a relative change in QRS amplitude as opposed to merely falling below a threshold."

About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty and our physicians in the top 1% of all physicians nationally by U.S. News & World Report.

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