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Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device
, Dian Andina Munawar, Ilaria Marcantoni, Iche Andriyani Liberty, Rido Mulawarman, Muhammad Hadi, Monica Trifitriana, Taufik Indrajaya, Muhammad Yamin, Irfannuddin Irfannuddin, Laura BurattiniAbstract
Background: Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology.
Methods: Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor Kardiamobile 6L portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method.
Results: A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 26.52 V vs. 44.72 38.21 V), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 34.42 V vs. 25.15 17.64 V, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R2 = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 27.14 V vs. 36.75 24.46 V, P = 0.34) and discharge (49.47 33.62 V vs. 61.09 35.99 V, P = 0.33).
Conclusions: Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.
Cardiol Res. 2023;14(1):45-53
doi: https://doi.org/10.14740/cr1458