Hastanede yatan COVID-19 hastalarında elektrokardiyografik bulgular ve hidroksiklorokin + azitromisin tedavisinin kardiyak güvenliği
Öz
Amaç: Bu çalışma ile COVID-19 hastalarında 12-derivasyonlu elektrokardiyografinin (EKG) standart değerlendirmesine ek olarak yeni aritmi belirteçlerini ve tedavi etkisininin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Toplam 51 COVID-19 hastasının 12-derivasyonlu EKG si tedavi öncesi, tedavinin 2. ve 5. günlerinde geriye dönük olarak değerlendirildi. Hastalar COVID-19’a yönelik hidroksiklorokin (HCQ) + azitromisin veya sadece HCQ tedavisi aldı. Ciddi COVID-19 hastaları, pnömoni bulgularına ek olarak SpO2<90% veya solunum sayısı >30/dk olarak tanımlandı.
Bulgular: Hastaların %68,6’ı HCQ + azitromisin kombinasyon tedavisi alırken, %31,4 hasta sadece azitromisin tedavisi aldı. Tedavinin 2. gününde, kombinasyon tedavisi alanlarda ve sadece azitromisin alanlarda sadece kalp hızı istatistiksel olarak anlamlı değişken olarak bulundu. Tedavinin 5. gününde kalp hızına ek olarak ve cTpe değerleri her iki tedavi rejiminde istatistiksel olarak anlamlı olarak bulundu. Tedavi süresince her iki tedavi rejiminde Tpe düzeyleri istatistiksel anlamlı olarak artmasına rağmen, rölatif artış oranları istatistiksel olarak gruplar arası benzer bulundu.
Sonuç: Çalışma sonuçlarımız, kısa süreli hastanede yatan COVID-19 hastalarında kullandığımız HCQ/ azitromisin tedavisinin kabul edilebilir düzeyde kardiyak etki profiline sahip olduğunu göstermektedir.
Anahtar Kelimeler
Kaynakça
- 1. Miller IF, Becker AD, Grenfell BT, Metcalf CJE. Disease and healthcare burden of COVID-19 in the United States. Nat Med. 2020; 8:1212-1217.
- 2. Taza F, Zulty M, Kanwal A, Grove D. Takotsubo cardiomyopathy triggered by SARS-CoV-2 infection in a critically ill patient. BMJ Case Rep. 2020; 6:e236561.
- 3. Moroni F, Gramegna M, Ajello S, et al. Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic. JACC Case Rep. 2020; 10:1620-1624.
- 4. Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;6:1324-1329.
- 5. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;23:2033-2040.
- 6. Gaze DC. Clinical utility of cardiac troponin measurement in COVID-19 infection. Ann Clin Biochem. 2020; 3:202-205.
- 7. Sarayani A, Cicali B, Henriksen CH, Brown JD. Safety signals for QT prolongation or Torsades de Pointes associated with azithromycin with or without chloroquine or hydroxychloroquine [published online ahead of print, 2020 Apr 19]. Res Social Adm Pharm. 2020;S1551-7411(20)30391-0. doi:10.1016/j.sapharm.2020.04.016
- 8. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020: Epub ahead of print. DOI: 10.1001/jamacardio.2020.1017.
- 9. Naksuk N, Lazar S, Peeraphatdit TB. Cardiac safety of off-label COVID-19 drug therapy: a review and proposed monitoring protocol. Eur Heart J Acute Cardiovasc Care. 2020;3:215-221.
- 10. T.C. Saglik Bakanlıgı Halk Sagligi Genel Müdürlügü. COVID-19 (SARS-CoV2 enfeksiyonu) Rehberi (Bilim Kurulu Calısması). https://www.covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi, the last accessed date on 23 March, 2020.
- 11. Akkuş G, Sökmen Y, Yılmaz M, Bekler Ö, Akkuş O. Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves Disease Before and After Anti-Thyroid Therapy [published online ahead of print, 2020 Jul 29]. Endocr Metab Immune Disord Drug Targets. 2020;10.2174/1871530320666200729145100.
- 12. https://crediblemeds.org/index.php/drugsearch
- 13. Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;18:2352-2371.
- 14. Lazzerini PE, Boutjdir M, Capecchi PL. COVID-19, Arrhythmic Risk, and Inflammation: Mind the Gap!. Circulation. 2020;1:7-9.
- 15. Reddy V, Reddy V, Mangat S, et al. Wide complex tachycardia in a COVID-19 patient: What is the mechanism?. J Electrocardiol. 2020; 60: 200-202.
- 16. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;5:475-481.
- 17. Chen C, Zhou Y, Wang DW. SARS-CoV-2: a potential novel etiology of fulminant myocarditis. Herz. 2020;3:230-232.
- 18. Monzani A, Genoni G, Scopinaro A, et al. QTc evaluation in COVID-19 patients treated with chloroquine/hydroxychloroquine. Eur J Clin Invest. 2020;6:e13258. doi:10.1111/eci.13258.
- 19. Chorin E, Dai M, Shulman E, et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med. 2020;6:808-809. doi:10.1038/s41591-020-0888-2.
- 20. Akkuş O, Akkuş G, Kaypaklı O. The Possible Effects of Dapagliflozin on 12-derived Electrocardiogram in Patients with Type 2 Diabetes Mellitus. Endocr Metab Immune Disord Drug Targets. 2019;2:207-213.
- 21. Chua KC, Rusinaru C, Reinier K, et al. Tpeak-to-Tend interval corrected for heart rate: A more precise measure of increased sudden death risk? Heart Rhythm. 2016;11:2181-2185.
- 22. Lakkireddy DR, Chung MK, Gopinathannair R, et al. Guidance for Cardiac Electrophysiology During the COVID-19 Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association [published online ahead of print, 2020 Apr 1]. Heart Rhythm. 2020;S1547-5271(20)30289-7.
Electrocardiographic findings and cardiac safety of hydroxychloroquine+azithromycin in hospitalized patients with COVID-19
Öz
Purpose: The aim of this study was to determine the novel arrhythmia markers (Tpe, cTpe, cTpe/cQT) in addition to standard evaluation of 12-derived electrocardiography (ECG) and effects of therapy in patients with COVID-19.
Materials and Methods: We evaluated 12-derived ECG in 51 patients with COVID-19 at the pre-treatment stage and on the 2nd and 5th days of the treatment, retrospectively. Patients were treated by either hydroxychloroquine (HCQ) + azithromycin or HCQ alone. Severe COVID-19 patients were defined with the presence of clinical signs and symptoms of pneumonia plus SpO2<90%, or respiratory rate > 30 breathe/minute.
Results: While 68.6% of patients received HCQ + azithromycin combination therapy, 31.4% of patients received HCQ monotherapy. On the 2nd day of the treatment, heart rate was the only statistically significant variable either on the treatment of HCQ + azithromycin or HCQ alone. On the 5th day of treatment, in addition to the heart rate, Tpe and cTpe levels were also statistically significant among the whole treatment regimens. Although Tpe statistically significantly increased in both treatment strategies during treatment, increasing relative Tpe ratios were similar between both of the treatment strategies.
Conclusion: The results of our study suggests that those off-label drugs (HCQ/azithromycin) have an acceptable cardiac safety profile in COVID-19 disease during short hospitalization.
Anahtar Kelimeler
Kaynakça
- 1. Miller IF, Becker AD, Grenfell BT, Metcalf CJE. Disease and healthcare burden of COVID-19 in the United States. Nat Med. 2020; 8:1212-1217.
- 2. Taza F, Zulty M, Kanwal A, Grove D. Takotsubo cardiomyopathy triggered by SARS-CoV-2 infection in a critically ill patient. BMJ Case Rep. 2020; 6:e236561.
- 3. Moroni F, Gramegna M, Ajello S, et al. Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic. JACC Case Rep. 2020; 10:1620-1624.
- 4. Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;6:1324-1329.
- 5. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;23:2033-2040.
- 6. Gaze DC. Clinical utility of cardiac troponin measurement in COVID-19 infection. Ann Clin Biochem. 2020; 3:202-205.
- 7. Sarayani A, Cicali B, Henriksen CH, Brown JD. Safety signals for QT prolongation or Torsades de Pointes associated with azithromycin with or without chloroquine or hydroxychloroquine [published online ahead of print, 2020 Apr 19]. Res Social Adm Pharm. 2020;S1551-7411(20)30391-0. doi:10.1016/j.sapharm.2020.04.016
- 8. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020: Epub ahead of print. DOI: 10.1001/jamacardio.2020.1017.
- 9. Naksuk N, Lazar S, Peeraphatdit TB. Cardiac safety of off-label COVID-19 drug therapy: a review and proposed monitoring protocol. Eur Heart J Acute Cardiovasc Care. 2020;3:215-221.
- 10. T.C. Saglik Bakanlıgı Halk Sagligi Genel Müdürlügü. COVID-19 (SARS-CoV2 enfeksiyonu) Rehberi (Bilim Kurulu Calısması). https://www.covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi, the last accessed date on 23 March, 2020.
- 11. Akkuş G, Sökmen Y, Yılmaz M, Bekler Ö, Akkuş O. Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves Disease Before and After Anti-Thyroid Therapy [published online ahead of print, 2020 Jul 29]. Endocr Metab Immune Disord Drug Targets. 2020;10.2174/1871530320666200729145100.
- 12. https://crediblemeds.org/index.php/drugsearch
- 13. Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;18:2352-2371.
- 14. Lazzerini PE, Boutjdir M, Capecchi PL. COVID-19, Arrhythmic Risk, and Inflammation: Mind the Gap!. Circulation. 2020;1:7-9.
- 15. Reddy V, Reddy V, Mangat S, et al. Wide complex tachycardia in a COVID-19 patient: What is the mechanism?. J Electrocardiol. 2020; 60: 200-202.
- 16. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;5:475-481.
- 17. Chen C, Zhou Y, Wang DW. SARS-CoV-2: a potential novel etiology of fulminant myocarditis. Herz. 2020;3:230-232.
- 18. Monzani A, Genoni G, Scopinaro A, et al. QTc evaluation in COVID-19 patients treated with chloroquine/hydroxychloroquine. Eur J Clin Invest. 2020;6:e13258. doi:10.1111/eci.13258.
- 19. Chorin E, Dai M, Shulman E, et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med. 2020;6:808-809. doi:10.1038/s41591-020-0888-2.
- 20. Akkuş O, Akkuş G, Kaypaklı O. The Possible Effects of Dapagliflozin on 12-derived Electrocardiogram in Patients with Type 2 Diabetes Mellitus. Endocr Metab Immune Disord Drug Targets. 2019;2:207-213.
- 21. Chua KC, Rusinaru C, Reinier K, et al. Tpeak-to-Tend interval corrected for heart rate: A more precise measure of increased sudden death risk? Heart Rhythm. 2016;11:2181-2185.
- 22. Lakkireddy DR, Chung MK, Gopinathannair R, et al. Guidance for Cardiac Electrophysiology During the COVID-19 Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association [published online ahead of print, 2020 Apr 1]. Heart Rhythm. 2020;S1547-5271(20)30289-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Bulaşıcı Hastalıklar |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2021 |
| Kabul Tarihi | 20 Nisan 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 46 Sayı: 2 |
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