Comparison of ECG Features, Cardiac Biomarkers, and Clinical Outcomes In Three Waves of Hospitalized COVID-19 Pneumonia Patients with Cardiovascular Events

Authors

• Yuchen HanFollow
• Jahnavi SunkaraFollow
• Tshura S AliFollow
• Harideep SamanapallyFollow
• Vidyulata SalunkheFollow
• Fnu DeeptiFollow
• Emma C. Huang, University of LouisvilleFollow
• Justin J. Huang, University of LouisvilleFollow
• Maiying Kong, University of LouisvilleFollow
• Jiapeng Huang, University of LouisvilleFollow

IRB # 20.0257

Funder

Jiapeng Huang, is supported by National Center for Advancing Translational Sciences 4U18TR003787, National Institute of Environmental Health Sciences P30ES030283, National Institute of General Medical Sciences P20GM155899. Jiapeng Huang is supported by Gilead Sciences (IN-US-983-6063), and the American Heart Association (23CSA1052735) The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Gilead Sciences or the American Heart Association.

Abstract

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and gaps between study periods reflected intervals during which the three variants were not dominant.

Results

Wave 1 showed significantly higher right bundle branch block (RBBB) (19.4% vs. 6.1%, P = 0.019) and brain natriuretic peptide (BNP) levels (4,598.73±7,764.72 vs. 1,161.33±3,305.48 pmol/L, P = 0.016) in cardiovascular patients on the first electrocardiogram (ECG). On the event triggered ECG, Wave 1 had higher ventricular/pacing rhythm and ST elevation than Wave 2 (8.9% vs. 2.3%, P = 0.033; 6.9% vs. 1.6%, P = 0.039). Wave 2 demonstrated elevated heart rate on the event triggered ECG among non-survivors (115.23±30.7 vs. 99.23±32.2, P = 0.012) and was associated with intensive care unit [1] length of stay (LOS) (ρ = 0.288, P = 0.045). First troponin and BNP levels in sinus rhythm were higher in Wave 3 than Wave 1 (1.7±3.6 vs. 0.2±0.7, P = 0.046). Wave 3 had shorter hospital LOS for survivors at first ECG (median: 8 days), but higher mortality rates for sinus rhythm at event triggered ECG compared to Wave 1 (7.1% vs. 51.6%, P = 0.029).

Conclusion

Distinct patterns in ECG parameters, cardiac biomarkers, and clinical outcomes in hospitalized COVID-19 patients offer valuable insight into cardiac manifestations of COVID-19, especially as vaccination rates and clinical practices evolve.

Notes

N/A

DOI

10.55504/2473-2869.1298

ORCID

0000-0002-4794-8400

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Han, Yuchen; Sunkara, Jahnavi; Ali, Tshura S; Samanapally, Harideep; Salunkhe, Vidyulata; Deepti, Fnu; Huang, Emma C.; Huang, Justin J.; Kong, Maiying; and Huang, Jiapeng (2026) "Comparison of ECG Features, Cardiac Biomarkers, and Clinical Outcomes In Three Waves of Hospitalized COVID-19 Pneumonia Patients with Cardiovascular Events," The University of Louisville Journal of Respiratory Infections: Vol. 9 : Iss. 1 , Article 3.
DOI: https://doi.org/10.55504/2473-2869.1298
Available at: https://ir.library.louisville.edu/jri/vol9/iss1/3