J-Waves in Acute COVID-19: A Novel Disease Charachteristic and Predictor of Mortality?

Introduction: While COVID-19 primarily affects the respiratory system, cardiac injury and unspecific ECG-alterations were reported. J-waves are a common finding observed in 5-6% of routine ECGs. They are also linked to several cardiac pathologies including ventricular tachycardia (VT). However, their incidence and association with acute COVID-19 were not investigated, yet. Methods: To study this issue, we retrospectively investigated admission ECGs in 386 consecutive patients hospitalized in a single center due to acute COVID-19 pneumonia. ECGs were evaluated for the incidence of J-waves and linked to clinical characteristics including 28-days mortality. Results: In contrast to the general population, in acute COVID-19, J-waves were revealed in 12.2% of patients. Patients with J-waves were older, female, with history of stroke or heart failure, and presented with higher BMI and CRP levels. Furthermore, while VT related death (n=1/7) was also observed in the J-wave cohort, mortality was significantly higher in these patients (J-wave: 14.9% vs. no-J-waves 3.8%, p=0.001). Indeed, even after adjusting for further confounders in a multivariable cox regression model, incidence of J-waves, was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15-6.63; p=0.023). While this ECG finding was linked to case fatality, it disappeared or declined during follow-up in 36.4% of COVID-19 survivors initially presented with J-waves. Conclusions: J-waves are a frequent, partially-transient finding in admission ECGs of patients hospitalized with COVID-19. They seem to be an independent predictor of 28-day mortality. Whether such novel feature is specific of COVID-19 and its relation to COVID-19 pathophysiology require further investigation. Funding: None to declare. Conflict of Interest: The authors declare no conflicts of interests. Ethical Approval: The study was performed in accordance with standards of good clinical practice and the principles of the Declaration of Helsinki and approved by the Ethic committee of the Bashkir State Medical University (N11, 2020).