Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study (2024)

Samat, A. H. A., Cassar, M. P., Akhtar, A. M., McCracken, C., Ashkir, Z. M., Mills, R., Moss, A. J., Finnigan, L. E. M., Lewandowski, A. J., Mahmod, M., Ogbole, G. I., Tunnicliffe, E. M., Lukaschuk, E., Piechnik, S. K., Ferreira, V. M., Nikolaidou, C., Rahman, N. M., Ho, L. P., Harris, V. C. (2024). Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study. International Journal of Cardiology, 415, Article 132415. https://doi.org/10.1016/j.ijcard.2024.132415

Samat, Azlan Helmy Abd ; Cassar, Mark P. ; Akhtar, Abid M. et al. / Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients : a prospective multicenter study. In: International Journal of Cardiology. 2024 ; Vol. 415.

@article{7546ffdf2c3f43dca64ac41db6ac4ae2,

title = "Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study",

abstract = "BackgroundThe role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients.MethodsPost-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.ResultsAt a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47–0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55–0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.ConclusionPost-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.",

keywords = "CMR, ECG, Electrocardiogram, Repolarisation, SARS-CoV-2",

author = "Samat, {Azlan Helmy Abd} and Cassar, {Mark P.} and Akhtar, {Abid M.} and Celeste McCracken and Ashkir, {Zakariye M.} and Rebecca Mills and Moss, {Alastair J.} and Finnigan, {Lucy E.M.} and Lewandowski, {Adam J.} and Masliza Mahmod and Ogbole, {Godwin I.} and Tunnicliffe, {Elizabeth M.} and Elena Lukaschuk and Piechnik, {Stefan K.} and Ferreira, {Vanessa M.} and Chrysovalantou Nikolaidou and Rahman, {Najib M.} and Ho, {Ling Pei} and Harris, {Victoria C.} and Amisha Singapuri and Charlotte Manisty and O'Regan, {Declan P.} and Weir-McCall, {Jonathan R.} and Steeds, {Richard P.} and Krisnah Poinasamy and Cuthbertson, {Dan J.} and Kemp, {Graham J.} and Alexander Horsley and Miller, {Christopher A.} and Caitlin O'Brien and Amedeo Chiribiri and Francis, {Susan T.} and Chalmers, {James D.} and Sven Plein and Poener, {Ana Maria} and Wild, {James M.} and Treibel, {Thomas A.} and Michael Marks and Mark Toshner and Wain, {Louise V.} and Evans, {Rachael A.} and Brightling, {Christopher E.} and Stefan Neubauer and McCann, {Gerry P.} and Betty Raman",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors.",

year = "2024",

month = nov,

day = "15",

doi = "10.1016/j.ijcard.2024.132415",

language = "English",

volume = "415",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier",

}

Samat, AHA, Cassar, MP, Akhtar, AM, McCracken, C, Ashkir, ZM, Mills, R, Moss, AJ, Finnigan, LEM, Lewandowski, AJ, Mahmod, M, Ogbole, GI, Tunnicliffe, EM, Lukaschuk, E, Piechnik, SK, Ferreira, VM, Nikolaidou, C, Rahman, NM, Ho, LP, Harris, VC, Singapuri, A, Manisty, C, O'Regan, DP, Weir-McCall, JR, Steeds, RP, Poinasamy, K, Cuthbertson, DJ, Kemp, GJ, Horsley, A, Miller, CA, O'Brien, C, Chiribiri, A, Francis, ST, Chalmers, JD, Plein, S, Poener, AM, Wild, JM, Treibel, TA, Marks, M, Toshner, M, Wain, LV, Evans, RA, Brightling, CE, Neubauer, S, McCann, GP, Raman, B 2024, 'Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study', International Journal of Cardiology, vol. 415, 132415. https://doi.org/10.1016/j.ijcard.2024.132415

Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study. / Samat, Azlan Helmy Abd; Cassar, Mark P.; Akhtar, Abid M. et al.
In: International Journal of Cardiology, Vol. 415, 132415, 15.11.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients

T2 - a prospective multicenter study

AU - Samat, Azlan Helmy Abd

AU - Cassar, Mark P.

AU - Akhtar, Abid M.

AU - McCracken, Celeste

AU - Ashkir, Zakariye M.

AU - Mills, Rebecca

AU - Moss, Alastair J.

AU - Finnigan, Lucy E.M.

AU - Lewandowski, Adam J.

AU - Mahmod, Masliza

AU - Ogbole, Godwin I.

AU - Tunnicliffe, Elizabeth M.

AU - Lukaschuk, Elena

AU - Piechnik, Stefan K.

AU - Ferreira, Vanessa M.

AU - Nikolaidou, Chrysovalantou

AU - Rahman, Najib M.

AU - Ho, Ling Pei

AU - Harris, Victoria C.

AU - Singapuri, Amisha

AU - Manisty, Charlotte

AU - O'Regan, Declan P.

AU - Weir-McCall, Jonathan R.

AU - Steeds, Richard P.

AU - Poinasamy, Krisnah

AU - Cuthbertson, Dan J.

AU - Kemp, Graham J.

AU - Horsley, Alexander

AU - Miller, Christopher A.

AU - O'Brien, Caitlin

AU - Chiribiri, Amedeo

AU - Francis, Susan T.

AU - Chalmers, James D.

AU - Plein, Sven

AU - Poener, Ana Maria

AU - Wild, James M.

AU - Treibel, Thomas A.

AU - Marks, Michael

AU - Toshner, Mark

AU - Wain, Louise V.

AU - Evans, Rachael A.

AU - Brightling, Christopher E.

AU - Neubauer, Stefan

AU - McCann, Gerry P.

AU - Raman, Betty

N1 - Publisher Copyright:© 2024 The Authors.

PY - 2024/11/15

Y1 - 2024/11/15

N2 - BackgroundThe role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients.MethodsPost-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.ResultsAt a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47–0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55–0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.ConclusionPost-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.

AB - BackgroundThe role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients.MethodsPost-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.ResultsAt a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47–0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55–0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.ConclusionPost-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.

KW - CMR

KW - ECG

KW - Electrocardiogram

KW - Repolarisation

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85201752342&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2024.132415

DO - 10.1016/j.ijcard.2024.132415

M3 - Article

C2 - 39127146

AN - SCOPUS:85201752342

SN - 0167-5273

VL - 415

JO - International Journal of Cardiology

JF - International Journal of Cardiology

M1 - 132415

ER -

Samat AHA, Cassar MP, Akhtar AM, McCracken C, Ashkir ZM, Mills R et al. Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study. International Journal of Cardiology. 2024 Nov 15;415:132415. Epub 2024 Aug 23. doi: 10.1016/j.ijcard.2024.132415