The natural history of QTc interval and its clinical impact in coronavirus disease 2019 survivors after 1 year

Diana Mojón-Álvarez; Andrea Izquierdo; Héctor Cubero-Gallego; Alicia Calvo-Fernández; Jaume Marrugat; Silvia Pérez-Fernández; Paula Cabero; Claudia Solà-Richarte; Cristina Soler; Núria Farré; Beatriz Vaquerizo

doi:10.3389/fcvm.2023.1140276

The natural history of QTc interval and its clinical impact in coronavirus disease 2019 survivors after 1 year

Front Cardiovasc Med. 2023 Apr 6:10:1140276. doi: 10.3389/fcvm.2023.1140276. eCollection 2023.

Authors

Diana Mojón-Álvarez^{1

2}, Andrea Izquierdo^{1

2}, Héctor Cubero-Gallego^{1

3}, Alicia Calvo-Fernández^{1

2

4}, Jaume Marrugat^{5

6}, Silvia Pérez-Fernández⁷, Paula Cabero¹, Claudia Solà-Richarte¹, Cristina Soler¹, Núria Farré^{1

2

3

4}, Beatriz Vaquerizo^{1

2

3

4

5}

Affiliations

¹ Cardiology Department, Hospital del Mar, Barcelona, Spain.
² Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.
³ IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain.
⁴ Medicine Department, Pompeu Fabra University, Barcelona, Spain.
⁵ CIBER Group in Epidemiology and Public Heath (CIBERCV), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
⁶ REGICOR (Registre Gironí del Cor) Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
⁷ Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.

Abstract

Background and objective: Prolonged QTc interval on admission and a higher risk of death in SARS-CoV-2 patients have been reported. The long-term clinical impact of prolonged QTc interval is unknown. This study examined the relationship in COVID-19 survivors of a prolonged QTc on admission with long-term adverse events, changes in QTc duration and its impact on 1-year prognosis, and factors associated with a prolonged QTc at follow-up.

Methods: We conducted a single-center prospective cohort study of 523 SARS-CoV-2-positive patients who were alive on discharge. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval and repeated in 421 patients 7 months after discharge. Mortality, hospital readmission, and new arrhythmia rates 1 year after discharge were reviewed.

Results: Thirty-one (6.3%) survivors had a baseline prolonged QTc. They were older, had more cardiovascular risk factors, cardiac disease, and comorbidities, and higher levels of terminal pro-brain natriuretic peptide. There was no relationship between prolonged QTc on admission and the 1-year endpoint (9.8% vs. 5.5%, p = 0.212). In 84% of survivors with prolonged baseline QTc, it normalized at 7.9 ± 2.2 months. Of the survivors, 2.4% had prolonged QTc at follow-up, and this was independently associated with obesity, ischemic cardiomyopathy, chronic obstructive pulmonary disease, and cancer. Prolonged baseline QTc was not independently associated with the composite adverse event at 1 year.

Conclusions: Prolonged QTc in the acute phase normalized in most COVID-19 survivors and had no clinical long-term impact. Prolonged QTc at follow-up was related to the presence of obesity and previously acquired chronic diseases and was not related to 1-year prognosis.

Keywords: COVID-19; QTc interval; arrhythmia; electrocardiogram (ECG); mortality.