Prognostic Value of Electrocardiographic QRS
Diminution in Patients Hospitalized With COVID-19
or Influenza

Joshua Lampert, MD; Michael Miller, MSc; Jonathan Lee Halperin, MD; Connor Oates, MD; Gennaro Giustino, MD; Kyle Nelson, MD; Jason Feinman, MD; Nikola Kocovic, MD et al American Journal of Cardiology Published August 08, 2021


During the clinical care of hospitalized patients with COVID-19, diminished QRS amplitude on the surface electrocardiogram (ECG) was observed to precede clinical decompensation, culminating in death. This prompted investigation into the prognostic utility and
specificity of low QRS complex amplitude (LoQRS) in COVID-19. We retrospectively analyzed consecutive adults admitted to a telemetry service with SARS-CoV-2 (n = 140) or
influenza (n = 281) infection with a final disposition—death or discharge. LoQRS was
defined as a composite of QRS amplitude <5 mm or <10 mm in the limb or precordial
leads, respectively, or a ≥50% decrease in QRS amplitude on follow-up ECG during hospitalization. LoQRS was more prevalent in patients with COVID-19 than influenza
(24.3% vs 11.7%, p = 0.001), and in patients who died than survived with either COVID19 (48.1% vs 10.2%, p <0.001) or influenza (38.9% vs 9.9%, p <0.001). LoQRS was independently associated with mortality in patients with COVID-19 when adjusted for baseline
clinical variables (odds ratio [OR] 11.5, 95% confidence interval [CI] 3.9 to 33.8,
p <0.001), presenting and peak troponin, D-dimer, C-reactive protein, albumin, intubation, and vasopressor requirement (OR 13.8, 95% CI 1.3 to 145.5, p = 0.029). The median
time to death in COVID-19 from the first ECG with LoQRS was 52 hours (interquartile
range 18 to 130). Dynamic QRS amplitude diminution is a strong independent predictor
of death over not only the course of COVID-19 infection, but also influenza infection. In
conclusion, this finding may serve as a pragmatic prognostication tool reflecting evolving
clinical changes during hospitalization, over a potentially actionable time interval for clinical reassessment.

© 2021 Elsevier Inc. All rights reserved. (Am J Cardiol 2021;159:129−137)

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