Cardiovascular Clinical Research Research Articles

Cardiovascular Care and Research in the Asia-Pacific Region during the COVID-19 Pandemic: Insights from Early and Mid-career Physicians

Background: The COVID-19 pandemic imposed a significant burden on healthcare systems in the Asia-Pacific region and has had a varying impact on physicians at different stages of their career. This study sought to evaluate the personal perspectives and the experiences of early and mid-career cardiologists and cardiothoracic surgeons with regard to the impact of the pandemic in the region. Methods: A cross-sectional web-based survey was conducted from June to July 2023 among members of the Asian Pacific Society of Cardiology (APSC) young community. The survey aimed to assess the impact of COVID-19 on cardiovascular clinical care and research activities that contained sections on demographic information, pandemic-related clinical and research experiences, personal stories, and interest in long-COVID research. Results: Overall, 60 physicians (44%) in the APSC young community responded to the survey. Cardiovascular disease patient numbers initially dropped in 2020 during the pandemic’s early stages but gradually increased in the following 3 years. Non-cardiovascular patient care workloads also rose during the first 2 years of the pandemic. Respondents observed notable changes in clinical care, research and personal life. Positive aspects included increased adaptability and telemedicine adoption, while challenges involved higher workloads and stress. More than 70% expressed interest in understanding the impact of long COVID, with Southeast Asian members showing the highest levels of interest. Conclusion: This survey conducted in the aftermath of the pandemic shed light on the challenges experienced by early to mid-career Asia-Pacific cardiovascular physicians. Physicians at this career stage encounter distinctive hurdles that require thoughtful consideration and effective solutions.

Participation of transgender and gender diverse persons in cardiovascular clinical trials

Study objectiveTransgender persons face increased risk in developing cardiovascular diseases due to administration of hormonal therapy used for gender expression, or due to the presence of other risk factors, such as minority stress and difficulty to have full access to health care. Even though the need for gender diversity in research has been identified, the number of clinical trials including transgender persons remains low. The aim of this study was to highlight gaps in inclusion of transgender individuals in cardiovascular clinical research. Design, settingA search in the pubmed.com database, as well as in the clinicaltrials.gov repository, was performed with search terms regarding transgender persons and cardiovascular diseases. Main outcome measure(s)The inclusion of transgender persons in cardiovascular clinical trials was evaluated. Results and conclusionsThis study revealed that there is only a small number of cardiovascular clinical trials including or studying transgender persons. This finding demonstrates the overall lack of clinical trials regarding cardiovascular health in transgender individuals and is indicative of their under-representation in clinical research.

Unlocking Diversity in Cardiovascular Clinical Research: Lessons from the Screening for Cardiac Amyloidosis With Nuclear Imaging in a Minority Populations Study

The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations study seeks to determine the prevalence of transthyretin cardiac amyloidosis (ATTR-CA) among older Black or Caribbean Hispanic individuals with heart failure and an increased wall thickness. We noticed varied recruitment percentages across the recruiting sites and sought to determine the factors associated with greater percentage enrollment of eligible participants. The percentage of enrolled to eligible participants was calculated across study sites. Baseline demographic and clinical characteristics, health literacy, trust in providers, perceived discrimination, area deprivation index (ADI) and English proficiency were compared by site using Kruskal-Wallis's test or one-way ANOVA for continuous variables and the Chi-Square test or Fisher's exact test for categorical variables. Wilcoxon rank sum and Chi-Square tests, with multiple comparisons correction using the false discovery rate (FDR) method, were used as post-hoc analysis when results were statistically significant. Among the four recruiting sites, Boston Medical Center, Columbia University Irving Medical Center, Harlem Hospital and Yale University, which employed different recruitment approaches, the percentage of participants enrolled among eligible participants differed, with the highest rate at Harlem Hospital (n=149 of 310, 48%), followed by Yale University (n=27 of 67, 40%), Boston University (n=247 of 655, 38%), and Columbia University (n=137of 442, 32%), p <0.01. Direct recruitment by the primary cardiovascular care team providing clinical care was associated with higher percent enrolled across sites as were higher education levels and English proficiency. Enrollment differences across sites were not associated with the number of chronic diseases, physician trust, perceived discrimination, or health literacy. Recruitment of eligible under-represented minorities (URMs) in SCAN-MP was associated with approaches employed in recruitment, including direct initial contact by the primary cardiovascular care team providing the potential participant's clinical care. Such data may help improve approaches to more successful recruitment of URMs in clinical research.

Echo2Pheno: a deep-learning application to uncover echocardiographic phenotypes in conscious mice

Echocardiography, a rapid and cost-effective imaging technique, assesses cardiac function and structure. Despite its popularity in cardiovascular medicine and clinical research, image-derived phenotypic measurements are manually performed, requiring expert knowledge and training. Notwithstanding great progress in deep-learning applications in small animal echocardiography, the focus has so far only been on images of anesthetized rodents. We present here a new algorithm specifically designed for echocardiograms acquired in conscious mice called Echo2Pheno, an automatic statistical learning workflow for analyzing and interpreting high-throughput non-anesthetized transthoracic murine echocardiographic images in the presence of genetic knockouts. Echo2Pheno comprises a neural network module for echocardiographic image analysis and phenotypic measurements, including a statistical hypothesis-testing framework for assessing phenotypic differences between populations. Using 2159 images of 16 different knockout mouse strains of the German Mouse Clinic, Echo2Pheno accurately confirms known cardiovascular genotype–phenotype relationships (e.g., Dystrophin) and discovers novel genes (e.g., CCR4-NOT transcription complex subunit 6-like, Cnot6l, and synaptotagmin-like protein 4, Sytl4), which cause altered cardiovascular phenotypes, as verified by H&E-stained histological images. Echo2Pheno provides an important step toward automatic end-to-end learning for linking echocardiographic readouts to cardiovascular phenotypes of interest in conscious mice.Graphical abstract

COVID-19 and the Cardiovascular System: Requiem for a Medical Minotaur.

COVID-19 and the Cardiovascular System: Requiem for a Medical Minotaur.

Social Media and Sports Cardiology: Potential Pitfalls and the Importance of Informed Communication

HomeCirculationVol. 147, No. 19Social Media and Sports Cardiology: Potential Pitfalls and the Importance of Informed Communication No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextSocial Media and Sports Cardiology: Potential Pitfalls and the Importance of Informed Communication Jonathan H. Kim, Matthew W. Martinez and Michael J. Ackerman Jonathan H. KimJonathan H. Kim Correspondence to: Jonathan H. Kim, MD, MSc, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1750 Haygood Dr NE, HSRB II, Office N251, Atlanta, GA 30322. Email E-mail Address: [email protected] https://orcid.org/0000-0001-5885-0284 Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, GA (J.H.K.). Search for more papers by this author , Matthew W. MartinezMatthew W. Martinez Atlantic Health, Morristown Medical Center, NJ (M.W.M.). Search for more papers by this author and Michael J. AckermanMichael J. Ackerman https://orcid.org/0000-0002-8011-3333 Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic; and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.J.A.). Search for more papers by this author Originally published8 May 2023https://doi.org/10.1161/CIRCULATIONAHA.123.064082Circulation. 2023;147:1419–1421FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 1420–1421.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Jonathan H. Kim, MD, MSc, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1750 Haygood Dr NE, HSRB II, Office N251, Atlanta, GA 30322. Email jonathan.[email protected]edu

Global trend and future landscape of coronary microcirculation: A bibliometric and visualized analysis from 1990 to 2021

BackgroundCoronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac requirements, which has aroused wide concerns in basic science and clinical cardiovascular research. We aimed to analyze coronary microcirculation-associated literatures over 30 years and provide insightful information on the evolutionary path, frontier research hotspots, and future developmental trends. MethodsPublications were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer was used to perform co-occurrence analyses for countries, institutions, authors, and keywords and to generate visualized collaboration maps. CiteSpace was used to visualize the knowledge map derived from reference co-citation analysis, burst references, and keywords detection. ResultsThis analysis was performed based on 11,702 publications including 9981 articles and 1721 reviews. The United States and Harvard University ranked at the top among all the countries and institutions. The majority of articles were published in Circulation, and it also was the most co-cited journal. Thematic hotspots and frontiers were focused on coronary microvascular dysfunction, magnetic resonance imaging, fractional flow reserve, STEMI, and heart failure. Additionally, keywords burst and co-occurrence cluster analysis showed that management, microvascular dysfunction, microvascular obstruction, prognostic value, outcomes, and guidelines were current knowledge gaps and future directions. ConclusionsCoronary microcirculation presented a research hotspot relevant wide spectrum of cardiovascular diseases. Definite diagnostics and prognostics are particularly valued. The protection of cardiovascular events that influence clinical outcomes should be an insightful concern in the future. Multidisciplinary collaborations will provide significant advances for the development of coronary microcirculation.

Harnessing Electronic Medical Records in Cardiovascular Clinical Practice and Research.

The use of electronic medical records has rapidly been adopted world-wide, which has resulted in multiple new opportunities for cardiovascular research. These include the following: (1) the development and assessment of clinical decision tools, meant to increase quality of care; (2) harnessing data linkages to examine genetic, epidemiological, and pharmacological associations on an unprecedented scale; and (3) harnessing electronic medical records to facilitate the conduct of cardiovascular clinical trials. While these opportunities promise to revolutionize cardiovascular care and research, enthusiasm should be tempered while further assessment of true clinical utility has been undertaken.

One-Year Follow-Up of Vascular Intervention Trials Disrupted by the COVID-19 Pandemic: A Use-Case landscape

IntroductionThe COVID-19 pandemic had an unprecedented impact on cardiovascular clinical research. The decision-making and state of study operations in cardiovascular trials 1-year after interruption has not been previously described. MethodsIn the spring of 2020, we created a pandemic impact task force to develop a landscape of use case scenarios from 17 device trials of peripheral artery disease (PAD) and coronary artery disease (CAD) interventions. In conjunction with publicly available (clinictrials.gov) study inclusion criteria, primary endpoints and study design, information was shared for this use-case landscape by trial leadership and data owners. ResultsA total of 17 actively enrolling trials (9 CAD and 8 PAD) volunteered to populate the use case landscape. All 17 were multicenter studies (12 in North America and 5 international). Fifteen studies were industry-sponsored, of which 13 were FDA approved IDEs, one was PCORI-sponsored and two were sponsored by the NIH. Enrollment targets ranged from 150 to 9000 pts. At the time of interruption, 5 trials were <20 % enrolled, 9 trials were 50–80 % enrolled and 3 trials were >80 % enrolled. At 1 year, the majority of studies were continuing to enroll in the context of more sporadic but ongoing pandemic activity. ConclusionsAt 1 year from the first surge interruptions, most trials had resumed enrollment. Trials most heavily interrupted were trials early in enrollment and those trials not able to pivot to virtual patient and site visits. Further work is needed to determine the overall impact on vascular intervention trials disrupted during the COVID-19 pandemic.

Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

SummaryBackgroundExercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group.MethodsThe study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18–35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m2. The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24–29, 30–35 years) and gestational age at birth (<32, 32–37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60–80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552).FindingsEnrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up.IntepretationThese results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults.FundingWellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.

Methodological Quality and Risk of Bias Assessment of Cardiovascular Disease Research: Analysis of Randomized Controlled Trials Published in 2017.

BackgroundAll randomized-controlled trials (RCTs) are required to follow high methodological standards. In this study, we aimed to assess the methodological quality of published cardiovascular clinical research trials in a representative sample of RCTs published in 2017.MethodsCochrane Central Register of Controlled Trials was used to identify cardiovascular clinical research trials with adult participants published in 2017. Overall, 250 (10%) RCTs were randomly selected from a total of 2,419 studies. Data on general trial characteristics were extracted and the risk of bias (RoB) was determined.ResultsOverall, 86% of RCTs have reported at least one statistically significant result, with the primary outcome significant in 69%, treatment favored in 55%, and adverse events reported in 68%. Less than one-third (29%) of trials were overall low RoB, while the other two-thirds were rated unclear (40%) or with high RoB (31%). Sequence generation, allocation concealment, and selective reporting were the domains most often rated with high RoB. Drug trials were more likely to have low RoB than non-drug trials. Significant differences were found in RoB for the allocation concealment and blinding of participants and personnel between industry-funded and non-industry-funded trials, with industry-funded trials more often rated at low RoB.ConclusionAlmost two-thirds of RCTs in the field of cardiovascular disease (CVD) research, were at high or unclear RoB, indicating a need for more rigorous trial planning and conduct. Prospective trial registration is a factor predicting a lower risk of bias.

What Are Adaptive Platform Clinical Trials and What Role May They Have in Cardiovascular Medicine?

HomeCirculationVol. 145, No. 9What Are Adaptive Platform Clinical Trials and What Role May They Have in Cardiovascular Medicine? No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextWhat Are Adaptive Platform Clinical Trials and What Role May They Have in Cardiovascular Medicine? Patrick R. Lawler, MD, MPH, Judith S. Hochman, MD, MA and Ryan Zarychanski, MD, MSc Patrick R. LawlerPatrick R. Lawler Correspondence to: Patrick R. Lawler, MD, MPH, Peter Munk Cardiac Centre, Toronto General Hospital, RFE3-410, 190 Elizabeth St, Toronto, ON, Canada M5G 2C4. Email E-mail Address: [email protected] https://orcid.org/0000-0001-5155-5071 Peter Munk Cardiac Centre, Toronto General Hospital, Canada (P.R.L.). Division of Cardiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (P.R.L.). Search for more papers by this author , Judith S. HochmanJudith S. Hochman https://orcid.org/0000-0002-5889-5981 Cardiovascular Clinical Research Center and Division of Cardiology, New York University Langone Health, New York University Grossman School of Medicine (J.S.H.). Search for more papers by this author and Ryan ZarychanskiRyan Zarychanski University of Manitoba, Max Rady College of Medicine, Department of Internal Medicine, Sections of Hematology/Medical Oncology and Critical Care, Winnipeg, Canada (R.Z). CancerCare Manitoba, Department of Medical Oncology and Hematology, Winnipeg, Canada (R.Z.). Search for more papers by this author Originally published28 Feb 2022https://doi.org/10.1161/CIRCULATIONAHA.121.058113Circulation. 2022;145:629–632FootnotesCirculation is available at www.ahajournals.org/journal/circThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 632.Correspondence to: Patrick R. Lawler, MD, MPH, Peter Munk Cardiac Centre, Toronto General Hospital, RFE3-410, 190 Elizabeth St, Toronto, ON, Canada M5G 2C4. Email patrick.[email protected]ca

Weaknesses in Experimental Design and Reporting Decrease the Likelihood of Reproducibility and Generalization of Recent Cardiovascular Research.

Recent evidence indicates that many clinical and preclinical studies are not reproducible. Prominent causes include design and implementation issues, low statistical power, unintentional bias, and incomplete reporting in the published literature. The primary goal of this study was to assess the quality of published research in three prominent cardiovascular research journals by examining statistical power and assessing the adherence to augmented ARRIVE guidelines (Animal Research: Reporting of In Vivo Experiments). For unpaired t-tests, the average median power for a 20% and 50% change was 0.27 ± 0.06 and 0.88 ± 0.08, respectively. For analysis of guidelines, 40 categories were assessed with a 0-2 scale. Although many strengths were observed, several key elements that were needed for reproducibility were inadequate, including differentiation of primary and secondary outcomes, power calculations for group size, allocation methods, use of randomization and blinding, checks for normality, reports of attrition, and adverse events of subjects, and assessment of bias. A secondary goal was to examine whether a required checklist improved the quality of reporting; those results indicated that a checklist improved compliance and quality of reporting, but adequacy levels in key categories were still too low. Overall, the findings of this study indicated that the probability for reproducibility of many clinical and preclinical cardiovascular research studies was low because of incomplete reporting, low statistical power, and lack of research practices that decrease experimental bias. Expansion of group sizes to increase power, use of detailed checklists, and closer monitoring for checklist adherence by editors and journals should remediate many of these deficits and increase the likelihood of reproducibility.

Identification of Circumferential Pulmonary Vein Isolation Gaps and Critical Atrial Substrate From HD Grid Maps in Atrial Fibrillation Patients: Insights From Omnipolar Technology

Identification of Circumferential Pulmonary Vein Isolation Gaps and Critical Atrial Substrate From HD Grid Maps in Atrial Fibrillation Patients: Insights From Omnipolar Technology

Patient partnership in cardiovascular clinical trials.

Patients are ultimately the end-users of medical therapies and need to be actively integrated as contributors and decision-makers in the process of product development throughout product lifecycles. This is increasingly being recognized by patients, investigators, regulators, payers, sponsors, and medical journals. However, cardiovascular research remains behind other fields in terms of the extent of patient involvement and awareness of clinical trials in cardiovascular research. True patient partnerships in cardiovascular therapeutic development may permit more rapid recognition of unmet needs, ensure alignment of product development priorities with patient priorities, improve efficiency of trials (e.g. recruitment), and ensure outcomes of value to patients are being measured in trials (e.g. quality of life). This paper reviews ongoing initiatives and remaining opportunities to accomplish contributive patient involvement in cardiovascular clinical research.

Improve the quality of clinical cardiovascular research in China with the help of artificial intelligence

随着人工智能技术的迅速发展，心血管领域迎来了革命性突破的契机，但目前该技术的实际应用尚未完全融入临床工作流程中。本期内容分享了我国心血管医生在人工智能辅助心血管疾病诊治和临床研究方面的良好尝试和初步成效，以期推动人工智能与心血管领域的深度融合，造福广大心血管疾病患者。.

Abstract 13425: Relationship Between Social Vulnerability and Case Fatality Rate at the Level of Counties and County-Equivalents in the Contiguous United States During the COVID-19 Pandemic

Introduction: Pandemics prior to the COVID-19 pandemic have been known to disproportionately affect counties and county-equivalents with high social vulnerability. Social vulnerability refers to the potential negative effects on communities caused by external stresses on human health. Such stresses include natural or human-caused disasters, or disease outbreaks. On the other hand, case fatality rate estimates the proportion of deaths among identified confirmed cases. Hypothesis: A higher social vulnerability is associated with a higher case fatality rate at the levels of counties and county-equivalents in the contiguous United States during the COVID-19 pandemic. Methods: Data from 2990 counties and county-equivalents such as independent cities, districts, and parishes that are considered county-equivalents for census purposes was analyzed. Counties and county-equivalents from the non-contiguous states of Alaska and Hawaii were excluded as well as 59 counties and county-equivalents without available SVI data and/or available CFR data. Available SVI public source data was collected from the Centers for Disease Control and Prevention, while available CFR public source data was collected from the Emory Clinical Cardiovascular Research Institute. Results: Median SVI was 0.5185 [Range: 0.0006-1] and median CFR was 1.56% [Range: 0%-8.77%]. A vaccination rate ratio (RR) and 95% CI for SVI was calculated using Wald’s unconditional maximum likelihood estimation to compare CFRs of counties and county-equivalents with low social vulnerability (SVI: 0%-33%), moderate social vulnerability (33%-66%), and high social vulnerability (66%-100%). A higher SVI was associated with a higher CFR such that the RR for relative differences in CFR between counties and county-equivalents with a low social vulnerability and counties and county-equivalents with a high social vulnerability was 0.83, while the RR for relative differences in CFR between counties and county-equivalents with a moderate social vulnerability and counties and county-equivalents with a high social vulnerability was 0.89. Conclusions: Public policy interventions need to target counties and county-equivalents with a higher social vulnerability to help the most vulnerable of people.

Cardiac Scintigraphy and Screening for Transthyretin Cardiac Amyloidosis: Caveat Emptor.

Cardiac Scintigraphy and Screening for Transthyretin Cardiac Amyloidosis: Caveat Emptor.

The British Cardiovascular Society Young Investigator Award 2021

Five finalists were selected for the 2021 British Cardiovascular Society (BCS) Young Investigator Award (YIA) from a competitive pool of young researchers. At the virtual BCS meeting in June, each...

Repolarization abnormalities at admission predict 30-day outcome in COVID-19

Funding AcknowledgementsType of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): BV is supported by a research grant of the Frans Van de Werf Fund for Clinical Cardiovascular Research.IntroductionCOVID-19 can be related with a poor clinical outcome. ECG abnormalities in COVID-19 have been widely described, but literature on the predictive value of a 12-lead ECG at hospital admission and normalization of these abnormalities after infection is limited.PurposeTo describe the predictive value of ECG abnormalities on admission and after recovery of COVID-19.MethodsAfter informed consent patients older than 18 years admitted with COVID-19 between March and July 2020 were included in a prospective registry. Diagnosis was confirmed by PCR-assay or based on suggestive clinical and radiological presentation. Demographic and clinical data were collected by review of the electronic medical record. All ECGs from admission until last follow-up were assessed lead by kead for repolarization abnormalities. The index ECG was defined as first ECG available after admission, a post-COVID ECG was obtained after hospital discharge in the absence of acute pathology. Minor abnormalities included iso-electric T-waves and ST-depression ≤2 mm. Major abnormalities were ST-depression >2 mm, ST-elevation, biphasic T-waves and T-wave inversion. Myocardial regions were defined as anterior (V1-V4), lateral (I, aVL, V5, V6) and inferior (II, III, aVF). Patients with a ventricular pacemaker were excluded.ResultsA total of 283 patients were included, median age 65 years and 64.7% were male. The 30-day mortality rate was 20.5%. In 96.8% of patients an ECG was available within 48 hours after admission.Repolarization abnormalities were observed in 48.8% of patients. In 27.2% this was limited to minor abnormalities. Abnormal repolarization was related to age, cardiovascular medical history, renal function, high-sensitive troponin-T and NT-proBNP levels. There were no significant differences in clinical presentation, ICU admission, need for ventilation or ECMO.On Kaplan-Meier analysis (figure) the presence (p < 0.001) and the extent of repolarization abnormalities (p < 0.001) were associated with 30-day mortality. Forward Cox regression modelling identiefied age (per year, HR 1.07, 95% CI 1.05-1.09), history of heart failure (HR 2.12, 95% CI 1.08-4.52), neurological disorders (HR 2.47, 95% CI 1.36-4.51), active oncological disease (HR 2.13, 95% CI 1.01-4.50) and the extent of repolarization abnormalities (per region, HR 1.37, 95% CI 1.05-1.79) as independent predictors.A post-COVID ECG was available in 172 patients (60.8%), the median time between index and post-COVID ECG was 63.3 days. There was 1 new first-degree AV-block and 1 new RBBB. Repolarization abnormalities were present in 32 patients (11.3%); however, only 3 patients (1.7%) had new abnormalities, 2 of whom died during further follow-up.ConclusionsThe extent of repolarization abnormalities on an ECG at admission for COVID-19 is an independent predictor of 30-day mortality. New ECG abnormalities after COVID-19 infection are uncommon but may be associated with adverse outcome. Figure.