PM1020: Electrocardiogram Abnormalities in Patients with Acute covid-19 Infection: What Is Its Significance?

Background: Covid-19 infection may impact the cardiovascular system resulting in abnormal electrocardiographic (EKG) findings. Anecdotally, we observed EKG abnormalities in pediatric patients with acute Covid infection without more significant cardiac disease requiring cardiology follow-up/intervention. We hypothesized that EKG abnormalities do not always correlate with significant cardiac pathology in this cohort. Our primary objective was to determine if EKG abnormalities in patients with acute Covid-19 infection correlate with worse outcomes (death, heart transplant, ECMO). Secondary objectives included description of EKG abnormalities, correlation of abnormalities with echocardiogram (echo) findings, and hospital/ICU length of stay.

Methods: After IRB approval, a retrospective chart review was performed of patients (0-21 years) diagnosed with Covid-19 by RT-PCR (March 2020 – November 2021) with an EKG during the same encounter. Patients with known congenital heart disease were excluded. Statistical analysis was performed using SAS software version 9.4 (SAS Institute, Cary, NC). Descriptive analyses were utilized to summarize the derivative cohort characteristics. A measure of frequency with corresponding percentages was used for categorical data, and median and the interquartile range were utilized for continuous variables, all of which were non-normally distributed.

Results: In total, 212 patients met inclusion criteria. EKG abnormalities were identified in 86 (40.5%) patients (Table 1). Echo was performed in 31/212 (14.6%) patients with 6 being abnormal (Table 2). The most common EKG abnormality was non-specific ST-T wave changes (36/86, 42%). Four patients with non-specific ST-T wave changes had an echo, of which 2 were abnormal (depressed LV systolic function – EF 50%) and both had elevated BNP/troponin levels. The echo abnormalities in 3/6 patients could be classified as incidental, unrelated to the EKG abnormality. There was 1 death with no patients requiring ECMO/heart transplant and only 2 patients required ICU admission. The deceased was a 15-year-old female diagnosed with Covid eight days prior, who had respiratory distress for 2 days followed by acute respiratory failure at home. She was noted to be in cardiopulmonary arrest by EMS upon arrival. Her EKG at the time of Covid diagnosis had demonstrated LVH by voltage and non-specific ST-T wave changes, no echo was performed.

There was no significant association between EKG abnormalities and hospital admission (p=0.59), hospital length of stay (p=0.20), or ICU admission (p=0.79). The sensitivity and specificity of an abnormal EKG in predicting abnormal echo findings were 66% and 56%, respectively, with a positive and negative predictive value of 26% and 88%, respectively.

Conclusion: The incidence of adverse outcomes and abnormal echocardiograms in patients with acute Covid-19 infection with EKG abnormalities in the absence of other clinical/laboratory findings is low. A normal EKG is reassuring for the absence of cardiac pathology, but an abnormal EKG along with elevated BNP and troponin should raise the suspicion for potential cardiac involvement.