Prolonged QT Interval in SARS-CoV-2 Infection: Prevalence and Prognosis

• Main Authors: Núria Farré, Diana Mojón, Marc Llagostera, Laia C. Belarte-Tornero, Alicia Calvo-Fernández, Ermengol Vallés, Alejandro Negrete, Marcos García-Guimaraes, Yolanda Bartolomé, Camino Fernández, Ana B. García-Duran, Jaume Marrugat, Beatriz Vaquerizo
• Format: Article
• Language: English
• Published: MDPI AG 2020-08-01
• Series: Journal of Clinical Medicine
• Subjects: QT interval; COVID-19; hydroxychloroquine; azithromycin; prognosis; death
• Online Access: https://www.mdpi.com/2077-0383/9/9/2712

Background: The prognostic value of a prolonged QT interval in SARS-Cov2 infection is not well known. Objective: To determine whether the presence of a prolonged QT on admission is an independent factor for mortality in SARS-Cov2 hospitalized patients. Methods: Single-center cohort of 623 consecutive patients with positive polymerase-chain-reaction test (PCR) to SARS Cov2, recruited from 27 February to 7 April 2020. 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. A prolonged QT interval was defined as a corrected QT (QTc) interval >480 milliseconds. Patients were followed up with until 10 May 2020. Results: Sixty-one patients (9.8%) had prolonged QTc and only 3.2% had a baseline QTc > 500 milliseconds. Patients with prolonged QTc were older, had more comorbidities, and higher levels of immune-inflammatory markers. There were no episodes of ventricular tachycardia or ventricular fibrillation during hospitalization. All-cause death was higher in patients with prolonged QTc (41.0% vs. 8.7%, <i>p</i> < 0.001, multivariable HR 2.68 (1.58–4.55), <i>p</i> < 0.001). Conclusions: Almost 10% of patients with COVID-19 infection have a prolonged QTc interval on admission. A prolonged QTc was independently associated with a higher mortality even after adjustment for age, comorbidities, and treatment with hydroxychloroquine and azithromycin. An electrocardiogram should be included on admission to identify high-risk SARS-CoV-2 patients.