Abstract 16929: Right Heart Strain on Presenting 12-Lead Electrocardiogram Predicts Critical Illness in COVID-19

Abstract

Introduction: The world has been facing the COVID-19 pandemic. Primarily a pulmonary illness, most deaths have been caused by respiratory failure. Emerging information has revealed that cardiovascular complications, including cardiac injury and cor pulmonale, can also be life-threatening consequences of COVID-19. Hypothesis: Signs of right heart strain on presenting 12-lead ECG predicts mortality in patients admitted with COVID-19. Methods: We retrospectively evaluated 480 patients consecutively admitted with COVID-19. ECGs from the emergency department (ED) were read by G.S. and S.P. who were blinded to data and outcomes. Right heart strain (RHS) was defined by any new right axis deviation, S1Q3T3 pattern, incomplete or complete right bundle branch block, or ST Depressions with T-wave inversions in leads V1-3 or II, III, aVF. This study was approved by the Institutional Review Board (IRB# 13774). Results: ECGs from the ED were available for 314 patients who were included in the analysis. Almost all patients were in sinus rhythm with sinus tachycardia being the most frequent dysrhythmia. RHS findings were present in 12.7% of cases. RHS was significantly associated with mortality and was the strongest predictor even after multivariate regression for mortality [OR 18.3 (6.1-55.3), p<0.001] (figure 1, table 1). Conclusions: Among available clinical tools, ECGs are easily performed, cost-effective, and widely available. Patients with evidence of RHS on initial ECG had significantly higher rates of mortality which has not been previously reported. Given that respiratory failure is the most common cause of death in patients with COVID-19, this information is valuable.