Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases
Abstract
:1. Introduction
2. Case Presentation
2.1. Case 1
2.2. Case 2
2.3. Case 3
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Number of COVID-19 deaths reported to WHO. Available online: https://data.who.int/dashboards/covid19/deaths?n=c (accessed on 21 February 2024).
- Sharma, Y.P.; Agstam, S.; Yadav, A.; Gupta, A.; Gupta, A. Cardiovascular manifestations of COVID-19: An evidence-based narrative review. Indian J. Med. Res. 2021, 153, 7–16. [Google Scholar] [CrossRef] [PubMed]
- Madjid, M.; Safavi-Naeini, P.; Solomon, S.D.; Vardeny, O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol. 2020, 5, 831–840. [Google Scholar] [CrossRef] [PubMed]
- Azevedo, R.B.; Botelho, B.G.; Hollanda, J.V.G.; Ferreira, L.V.L.; Junqueira de Andrade, L.Z.; Oei, S.S.M.L.; Mello, T.S.; Muxfeldt, E.S. COVID-19 and the cardiovascular system: A comprehensive review. J. Hum. Hypertens. 2021, 35, 4–11. [Google Scholar] [CrossRef] [PubMed]
- Long, B.; Brady, W.J.; Bridwell, R.E.; Ramzy, M.; Montrief, T.; Singh, M.; Gottlieb, M. Electrocardiographic manifestations of COVID-19. Am. J. Emerg. Med. 2021, 41, 96–103. [Google Scholar] [CrossRef] [PubMed]
- Kinoshita, T.; Hashimoto, K.; Yoshioka, K.; Miwa, Y.; Yodogawa, K.; Watanabe, E.; Nakamura, K.; Nakagawa, M.; Nakamura, K.; Watanabe, T.; et al. Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings: The JANIES-SHD study. J. Cardiol. 2020, 75, 155–163. [Google Scholar] [CrossRef] [PubMed]
- Gatzoulis, K.A.; Tsiachris, D.; Arsenos, P.; Antoniou, C.K.; Dilaveris, P.; Sideris, S.; Kanoupakis, E.; Simantirakis, E.; Korantzopoulos, P.; Goudevenos, I.; et al. Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: The PRESERVE EF study. Eur. Heart J. 2019, 40, 2940–2949. [Google Scholar] [CrossRef] [PubMed]
- Bauer, A.; Malik, M.; Schmidt, G.; Barthel, P.; Bonnemeier, H.; Cygankiewicz, I.; Guzik, P.; Lombardi, F.; Müller, A.; Oto, A.; et al. Heart rate turbulence: Standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J. Am. Coll. Cardiol. 2008, 52, 1353–1365. [Google Scholar] [CrossRef] [PubMed]
- Yoshioka, K.; Amino, M.; Zareba, W.; Shima, M.; Matsuzaki, A.; Fujii, T.; Kanda, S.; Deguchi, Y.; Kobayashi, Y.; Ikari, Y.; et al. Identification of high-risk Brugada syndrome patients by combined analysis of late potential and T-wave amplitude variability on ambulatory electrocardiograms. Circ. J. 2013, 77, 610–618. [Google Scholar] [CrossRef] [PubMed]
- Hashimoto, K.; Harada, N.; Kasamaki, Y. Reference values for a novel ambulatory-based frequency domain T-wave alternans in subjects without structural heart disease. J. Cardiol. 2020, 76, 506–513. [Google Scholar] [CrossRef] [PubMed]
- Trachanas, K.; Sideris, S.; Arsenos, P.; Tsiachris, D.; Antoniou, C.K.; Dilaveris, P.; Triantafyllou, K.; Xenogiannis, I.; Tsimos, K.; Efremidis, M.; et al. Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRE-SERVE-EF study. Ann. Noninvasive Electrocardiol. 2022, 27, e12908. [Google Scholar] [CrossRef]
- Yakubo, S.; Ozawa, Y.; Saito, S.; Kasamaki, Y.; Komaki, K.; Hanakawa, K.; Sasaki, Y.; Aruga, M.; Miyazawa, I.; Kanda, T.; et al. Normal limits of high-resolution signal-averaged ECG parameters of Japanese adult men and women. J. Electrocardiol. 2000, 33, 225–231. [Google Scholar] [CrossRef] [PubMed]
- Yang, T.F.; Macfarlane, P.W. New sex dependent normal limits of the signal averaged electrocardiogram. Br. Heart J. 1994, 72, 197–200. [Google Scholar] [CrossRef] [PubMed]
- Lui, P.P.; Blet, A.; Smyth, D.; Li, H. The science underlying COVID-19: Implications for the cardiovascular system. Circulation 2020, 142, 68–78. [Google Scholar] [CrossRef]
- Hashimoto, K.; Kinoshita, T.; Miwa, Y.; Amino, M.; Yoshioka, K.; Yodogawa, K.; Nakagawa, M.; Nakamura, K.; Watanabe, E.; Nakamura, K.; et al. Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Dis-ease (JANIES-CKD) study. Ann. Noninvasive Electrocardiol. 2022, 27, e12923. [Google Scholar] [CrossRef]
- Steinberg, J.S.; Regan, A.; Sciacca, R.R.; Bigger, J.T., Jr.; Fleiss, J.L. Predicting arrhythmic events after acute myocar dial infarction using the signal-averaged electrocardiogram. Am. J. Cardiol. 1992, 69, 13–21. [Google Scholar] [CrossRef] [PubMed]
- Amit, G.; Rosenbaum, D.S.; Super, D.M.; Costantini, O. Microvolt T-wave alternans and electrophysiologic testing predict distinct arrhythmia substrates: Implications for identifying patients at risk for sudden cardiac death. Heart Rhythm 2010, 7, 763–768. [Google Scholar] [CrossRef] [PubMed]
- Watanabe, M.A.; Schmidt, G. Heart rate turbulence: A 5-year review. Heart Rhythm 2004, 1, 732–738. [Google Scholar] [CrossRef] [PubMed]
- Lindgren, K.S.; Mäkikallio, T.H.; Seppänen, T.; Raatikainen, M.J.; Castellanos, A.; Myerburg, R.J.; Huikuri, H.V. Heart rate turbulence after ventricular and atrial premature beats in subjects without structural heart disease. J. Cardiovasc. Electrophysiol. 2003, 14, 447–452. [Google Scholar] [CrossRef] [PubMed]
- Tondas, A.E.; Munawar, D.A.; Marcantoni, I.; Liberty, I.A.; Mulawarman, R.; Hadi, M.; Trifitriana, M.; Indrajaya, T.; Yamin, M.; Irfannuddin, I.; et al. Is T-wave alternans a repolarization abnormality marker in COVID-19? An investigation on the potentialities of portable electrocardiogram device. Cardiol. Res. 2023, 14, 45–53. [Google Scholar] [CrossRef]
- Mol, M.B.A.; Strous, M.T.A.; van Osch, F.H.M.; Vogelaar, F.J.; Barten, D.G.; Farchi, M.; Foudraine, N.A.; Gidron, Y. Heart-rate-variability (HRV), predicts outcomes in COVID-19. PLoS ONE 2021, 16, e0258841. [Google Scholar] [CrossRef]
- Duca, Ș.T.; Chetran, A.; Miftode, R.Ș.; Mitu, O.; Costache, A.D.; Nicolae, A.; Iliescu-Halițchi, D.; Halițchi-Iliescu, C.O.; Mitu, F.; Costache, I.I. Myocardial ischemia in patients with COVID-19 infection: Between pathophysiological mechanisms and elec-trocardiographic findings. Life 2022, 12, 1015. [Google Scholar] [CrossRef] [PubMed]
- Amarh, E.; Tisdale, J.E.; Overholser, B.R. Prolonged Exposure to Remdesivir Inhibits the Human Ether-A-Go-Go-Related Gene Potassium Current. J. Cardiovasc. Pharmacol. 2023, 82, 212–220. [Google Scholar] [CrossRef] [PubMed]
- Fung, J.S.; Levitan, M.; Landry, S.; McIsaac, S. Torsades de pointes associated with remdesivir treatment for COVID-19 pneumonia. J. Assoc. Med. Microbiol. Infect. Dis. Can. 2023, 8, 99–104. [Google Scholar] [CrossRef] [PubMed]
Characteristic | Case 1 | Case 2 | Case 3 |
---|---|---|---|
Age (years), sex | 78, female | 76, male | 67, male |
Race | Asian | Asian | Asian |
Prior history | Myasthenia gravis, postoperative phrenic nerve injury, and chronic kidney disease | Hypertension, diabetes mellitus, and cerebral infarction | Renal cancer, lung cancer, and pancreatic diabetes |
Medication for cardiac diseases | − | − | − |
Significant structured heart disease | − | − | − |
Medication for hypertension/diabetes/dyslipidemia | − | DPP-4 inhibitor, SGLT2 inhibitor, and metformin | Insulin |
Family history of sudden cardiac death | − | − | − |
History of smoking | − | + | + |
Vital signs upon admission | |||
Blood pressure, mmHg | 122/73 | 116/91 | 177/97 |
Pulse rate, beats per minute | 107 | 89 | 96 |
Body temperature, °C | 38.1 | 37.0 | 36.9 |
Respiratory rate, breaths per minute | 34 | 20 | 23 |
Oxygen saturation, % | 95 (with oxygen mask and reservoir bag, 8 L/min flow) | 95 (with oxygen mask, 4 L/min flow) | 96 (with oxygen mask, 3 L/min flow) |
12-lead electrocardiogram | |||
QT prolongation | − | − | − |
QT, millisecond | 352 | 382 | 427 |
QTc, millisecond | 406 | 384 | 432 |
ST-T changes | − | − | − |
Arrhythmia throughout hospitalization | |||
Atrial fibrillation | None | None | None |
PSVT | None | None | None |
Atrial tachycardia | None | None | None |
NSVT | None | None | None |
SVT | Positive | None | None |
PVC > 1000/24 h | None | None | Positive |
Finding | Case 1 | Case 2 | Case 3 |
---|---|---|---|
White blood cell count, μL | 12,000 | 10,900 | 7100 |
Hemoglobin, g/dL | 10.9 | 17.2 | 10.3 |
Platelet count × 104/μL | 23.3 | 10.2 | 23.9 |
AST, U/L | 20 | 44 | 19 |
ALT, U/L | 9 | 36 | 8 |
LDH, U/L | 251 | 417 | 137 |
Total protein, g/dL | 6.1 | 6.4 | 7.0 |
Albumin, g/dL | 3.1 | 3.1 | 2.0 |
BUN, mg/dL | 38 | 30 | 14 |
Creatinine, mg/dL | 1.53 | 1.11 | 0.57 |
eGFR, mL/min | 25.8 | 56.6 | 107.3 |
Procalcitonin, ng/dL | 0.3 | 0.4 | 0.17 |
CRP, mg/dL | 19.7 | 20.3 | 6.5 |
BNP, pg/mL | 178.3 | 20.3 | 162.0 |
Troponin I, pg/mL (reference value: <28.0) | 272.8 | 10.6 | N/A |
D-dimer, ng/mL | 1.0 | 1.8 | 3.5 |
SF, μg/mL (reference value: <3.0) | 33.3 | 26.9 | N/A |
Finding | Case 1 | Case 2 | Case 3 |
---|---|---|---|
IVS, mm | 8.5 | 7.0 | 9.3 |
LVDd, mm | 35.6 | 51.0 | 50.5 |
PWT, mm | 10.3 | 10.2 | 8.7 |
LVEF, % | 82.7 | 75.1 | 64.2 |
RVFAC, % | 44.4 | 53.9 | − |
TAPSE, mm | 20.5 | 22.7 | − |
Marker | Abnormal Value or Cutoff Value | Case 1 | Case 2 | Case 3 |
---|---|---|---|---|
Late potential | ||||
fQRS, millisecond | >135 | 128 | 136 | 160 |
RMS40, μV | <20 | 4.4 | 1.5 | 10.4 |
LAS40, millisecond | >38 | 60 | 53 | 57 |
Determination | Positive | Positive | Positive | |
T-wave alternans | ||||
Noise level, mV | (*1), (*2) | 10.0 | 9.6 | 12.3 |
TWA, μV | (*1), (*2) | 80.0 | 28.4 | 35.7 |
Determination | Positive | Positive | Positive | |
Heart rate variability | ||||
SDNN, millisecond | <75 | 41.6 | 64.0 | 64.0 |
Determination | Positive | Positive | Positive | |
Heart rate turbulence | ||||
TO, % | ≥0 | 0.01 | 0.01 | 0.01 |
TS, millisecond/RR interval | ≤2.5 | 1.30 | 1.00 | 1.00 |
Determination | Abnormal (Category 2) | Abnormal (Category 2) | Abnormal (Category 2) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kimata, M.; Hashimoto, K.; Harada, N.; Kawamura, Y.; Kimizuka, Y.; Fujikura, Y.; Kaneko, M.; Kiriu, N.; Sekine, Y.; Iwabuchi, N.; et al. Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases. Medicina 2024, 60, 655. https://doi.org/10.3390/medicina60040655
Kimata M, Hashimoto K, Harada N, Kawamura Y, Kimizuka Y, Fujikura Y, Kaneko M, Kiriu N, Sekine Y, Iwabuchi N, et al. Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases. Medicina. 2024; 60(4):655. https://doi.org/10.3390/medicina60040655
Chicago/Turabian StyleKimata, Motohiro, Kenichi Hashimoto, Naomi Harada, Yusuke Kawamura, Yoshifumi Kimizuka, Yuji Fujikura, Mayuko Kaneko, Nobuaki Kiriu, Yasumasa Sekine, Natsumi Iwabuchi, and et al. 2024. "Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases" Medicina 60, no. 4: 655. https://doi.org/10.3390/medicina60040655