Riassunto analitico
The rise of coronavirus disease 2019 (COVID-19), provoked by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major global public health emergency. Although SARS-CoV-2 causes primarily respiratory problems, concomitant cardiac injury cannot be ignored since it may be an independent incicator of adverse outcomes. Cardiac arrhythmias are often observed in patients with COVID-19, particularly in severe cases, and more likely lead to the high risk of negative outcomes. To investigate this occurrence, we performed a retrospective cohort study, in which we enrolled patients admitted to the emergency department at “Policlinico di Modena” and then hospitalized, with evidence of SARS-CoV-2 related pneumonia confirmed both by radiology and a positive nasopharyngeal swab. The analysis period spanned from March to December 2020. We selected 637 patients who fit enrollment criteria and have undergone an ECG during admission. Primary endpoint was 30-day and 180-day mortality comparation between arrhythmics and non arrhythmics patients. Among the 637 patients we identified 144 patients with Arrhythmias (22,6%). The analysis of 144 arrhythmics ECG showed 99 Sinus tachycardia (51%), 40 Sinus bradycardia (24%), 27 TachyFA (18%), 6 Bradycardia and BAV I° (4%), 1 BAV II° (0,7%), 1 BradyFA (0,7%), 1 Accelerated Idioventricular Rhythm (0,7%). Arrhythmic patients were older than non arrhytmic ones (age>75 years 46,5% vs. 40,4%; p=0,111), more frequently they presented BPCO (11,8% vs. 8.7%; p=0,170), Hypertension (57,6% Vs.55,2%; p=0,335), higher heart rate (98,83 ± 31,67 Vs. 80,08 ± 11,95; p=<0,01), Dyspnea (72,2% Vs. 63,7%), lower incidence of Cough (31,3% vs. 49,1%; p= <0.01), higher LDH (728,38 ± 523,57 Vs. 574,38 ± 223,43; p<0.01), higher white blood cell count (9,65 ± 7,06 Vs. 7,17 ± 3,38; p=<0.01) and higher Troponin (126,28 ± 296,82 Vs. 55,72 ± 187,2; p=0,013). Mortality in arrhythmic patients was higher, both at 30-day since admission (31.25% Vs. 15,4%; p=<0.01) and at 180-day (37.5% Vs. 20,2%; p=<0.01). Cumulative Survival Adjusted HR was significant both at 30-days (adjustedHR 2.30, 95%CI 1.59-3.32, p<0.001) and at 180-days (Adj. HR 2.15, 95%CI 1.54-3.03, p<0.001). Finally, mortality in Tachycardic patients was higher than in cumulative arrhytmics patients (30 day: 37,6% Vs. 31.25%; 180 day: 41,6% Vs. 37.5%). Collected data suggest statistically significant higher mortality rate for arrhytmics patients with COVID-19 both at 30 day and 180-day. Furthermore, Tachycardia appears as a very relevant risk factor for mortality both at 30-day and 180-day.
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