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Year : 2022  |  Volume : 25  |  Issue : 4  |  Page : 415-424

Electrocardiographic QRS axis shift, rotation and COVİD-19

Department of Cardiology, İnfectious Disease, Unıversity of Health Sciences, Keçiören Education and Training Hospital, Ankara, Turkey

Correspondence Address:
Dr. S Koc
Unıversity of Health Sciences, Keçiören Education and Training Hospital, Ankara
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_9_21

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Background: In patients with coronavirus disease-2019 (COVID-19), severe dyspnea is the most dramatic complication. Severe respiratory difficulties may include electrocardiographic frontal QRS axis rightward shift (Rws) and clockwise rotation (Cwr). Aim: This study investigated the predictability of advanced lung tomography findings with QRS axis shift and rotation. Patients and Methods: This was a retrospective analysis of 160 patients. Patients were divided into the following two groups: normal (n = 80) and low (n = 80) oxygen saturation. These groups were further divided into four groups according to the rightward and leftward axis shift (Lws) on the electrocardiographic follow-up findings. These groups were compared in terms of electrocardiographic rotation (Cwr, counterclockwise rotation, or normal transition), tomographic stage (CO-RADS5(advanced)/CO-RADS1–4), electrocardiographic intervals, and laboratory findings. Results: In patients with low oxygen saturation, the amount of QRS axis shift, Cwr, and tomographic stage were significantly higher in the Rws group than in the Lws group. There were no differences in the above parameters between the Rws and Lws groups in patients with normal oxygen saturation. Logistic regression analysis revealed that the presence of Cwr and Rws independently increased the risk of CO-RADS5 by 18.9 and 4.6 fold, respectively, in patients with low oxygen saturation. Conclusion: In COVID-19 patients who have dyspnea with low oxygen saturation, electrocardiographically clockwise rotation with a rightward axis shift demonstrated good sensitivity (80% [0.657–0.943]) and specificity (80% [0.552–>1]) for predicting advanced lung tomographic findings. ClinicalTrialsgov Identifier: NCT04698083.

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