CovidChloroV1, Main, Corpus, bibRecord, 001617

Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin.

Identifieur interne : 001617 ( Main/Corpus ); précédent : 001616; suivant : 001618

Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin.

Auteurs : Alberto Cipriani ; Alessandro Zorzi ; Davide Ceccato ; Federico Capone ; Matteo Parolin ; Filippo Donato ; Paola Fioretto ; Raffaele Pesavento ; Lorenzo Previato ; Pietro Maffei ; Alois Saller ; Angelo Avogaro ; Cristiano Sarais ; Dario Gregori ; Sabino Iliceto ; Roberto Vettor

Source :

International journal of cardiology [ 1874-1754 ] ; 2020.

RBID : pubmed:32439366

English descriptors

KwdEn :
- Antiviral Agents (administration & dosage), Antiviral Agents (adverse effects), Azithromycin (administration & dosage), Azithromycin (adverse effects), Betacoronavirus (isolation & purification), COVID-19 (MeSH), Coronavirus Infections (diagnosis), Coronavirus Infections (drug therapy), Coronavirus Infections (physiopathology), Death, Sudden, Cardiac (etiology), Death, Sudden, Cardiac (prevention & control), Drug Monitoring (methods), Electrocardiography (methods), Female (MeSH), Hospitalization (statistics & numerical data), Humans (MeSH), Hydroxychloroquine (administration & dosage), Hydroxychloroquine (adverse effects), Long QT Syndrome (chemically induced), Long QT Syndrome (complications), Long QT Syndrome (diagnosis), Male (MeSH), Middle Aged (MeSH), Outcome and Process Assessment, Health Care (MeSH), Pandemics (MeSH), Pneumonia, Viral (diagnosis), Pneumonia, Viral (drug therapy), Pneumonia, Viral (physiopathology), SARS-CoV-2 (MeSH).
MESH :
- chemical , administration & dosage : Antiviral Agents, Azithromycin, Hydroxychloroquine.
- chemical , adverse effects : Antiviral Agents, Azithromycin, Hydroxychloroquine.
- chemically induced : Long QT Syndrome.
- complications : Long QT Syndrome.
- diagnosis : Coronavirus Infections, Long QT Syndrome, Pneumonia, Viral.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- etiology : Death, Sudden, Cardiac.
- isolation & purification : Betacoronavirus.
- methods : Drug Monitoring, Electrocardiography.
- physiopathology : Coronavirus Infections, Pneumonia, Viral.
- prevention & control : Death, Sudden, Cardiac.
- statistics & numerical data : Hospitalization.
- COVID-19, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Pandemics, SARS-CoV-2.

Abstract

BACKGROUND

Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established.

METHODS

We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control.

RESULTS

Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability.

CONCLUSION

Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.

DOI: 10.1016/j.ijcard.2020.05.036
PubMed: 32439366
PubMed Central: PMC7235573

Links to Exploration step

pubmed:32439366

Le document en format XML

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<author><name sortKey="Saller, Alois" sort="Saller, Alois" uniqKey="Saller A" first="Alois" last="Saller">Alois Saller</name>
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<author><name sortKey="Avogaro, Angelo" sort="Avogaro, Angelo" uniqKey="Avogaro A" first="Angelo" last="Avogaro">Angelo Avogaro</name>
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</affiliation>
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<author><name sortKey="Sarais, Cristiano" sort="Sarais, Cristiano" uniqKey="Sarais C" first="Cristiano" last="Sarais">Cristiano Sarais</name>
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</affiliation>
</author>
<author><name sortKey="Gregori, Dario" sort="Gregori, Dario" uniqKey="Gregori D" first="Dario" last="Gregori">Dario Gregori</name>
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</affiliation>
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<author><name sortKey="Iliceto, Sabino" sort="Iliceto, Sabino" uniqKey="Iliceto S" first="Sabino" last="Iliceto">Sabino Iliceto</name>
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</affiliation>
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<author><name sortKey="Vettor, Roberto" sort="Vettor, Roberto" uniqKey="Vettor R" first="Roberto" last="Vettor">Roberto Vettor</name>
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<author><name sortKey="Donato, Filippo" sort="Donato, Filippo" uniqKey="Donato F" first="Filippo" last="Donato">Filippo Donato</name>
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<author><name sortKey="Fioretto, Paola" sort="Fioretto, Paola" uniqKey="Fioretto P" first="Paola" last="Fioretto">Paola Fioretto</name>
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<author><name sortKey="Pesavento, Raffaele" sort="Pesavento, Raffaele" uniqKey="Pesavento R" first="Raffaele" last="Pesavento">Raffaele Pesavento</name>
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</affiliation>
</author>
<author><name sortKey="Previato, Lorenzo" sort="Previato, Lorenzo" uniqKey="Previato L" first="Lorenzo" last="Previato">Lorenzo Previato</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Maffei, Pietro" sort="Maffei, Pietro" uniqKey="Maffei P" first="Pietro" last="Maffei">Pietro Maffei</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Saller, Alois" sort="Saller, Alois" uniqKey="Saller A" first="Alois" last="Saller">Alois Saller</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Avogaro, Angelo" sort="Avogaro, Angelo" uniqKey="Avogaro A" first="Angelo" last="Avogaro">Angelo Avogaro</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Sarais, Cristiano" sort="Sarais, Cristiano" uniqKey="Sarais C" first="Cristiano" last="Sarais">Cristiano Sarais</name>
<affiliation><nlm:affiliation>Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Gregori, Dario" sort="Gregori, Dario" uniqKey="Gregori D" first="Dario" last="Gregori">Dario Gregori</name>
<affiliation><nlm:affiliation>Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Iliceto, Sabino" sort="Iliceto, Sabino" uniqKey="Iliceto S" first="Sabino" last="Iliceto">Sabino Iliceto</name>
<affiliation><nlm:affiliation>Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vettor, Roberto" sort="Vettor, Roberto" uniqKey="Vettor R" first="Roberto" last="Vettor">Roberto Vettor</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</nlm:affiliation>
</affiliation>
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<series><title level="j">International journal of cardiology</title>
<idno type="eISSN">1874-1754</idno>
<imprint><date when="2020" type="published">2020</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiviral Agents (administration & dosage)</term>
<term>Antiviral Agents (adverse effects)</term>
<term>Azithromycin (administration & dosage)</term>
<term>Azithromycin (adverse effects)</term>
<term>Betacoronavirus (isolation & purification)</term>
<term>COVID-19 (MeSH)</term>
<term>Coronavirus Infections (diagnosis)</term>
<term>Coronavirus Infections (drug therapy)</term>
<term>Coronavirus Infections (physiopathology)</term>
<term>Death, Sudden, Cardiac (etiology)</term>
<term>Death, Sudden, Cardiac (prevention & control)</term>
<term>Drug Monitoring (methods)</term>
<term>Electrocardiography (methods)</term>
<term>Female (MeSH)</term>
<term>Hospitalization (statistics & numerical data)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (administration & dosage)</term>
<term>Hydroxychloroquine (adverse effects)</term>
<term>Long QT Syndrome (chemically induced)</term>
<term>Long QT Syndrome (complications)</term>
<term>Long QT Syndrome (diagnosis)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Outcome and Process Assessment, Health Care (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (diagnosis)</term>
<term>Pneumonia, Viral (drug therapy)</term>
<term>Pneumonia, Viral (physiopathology)</term>
<term>SARS-CoV-2 (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antiviral Agents</term>
<term>Azithromycin</term>
<term>Hydroxychloroquine</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiviral Agents</term>
<term>Azithromycin</term>
<term>Hydroxychloroquine</term>
</keywords>
<keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Long QT Syndrome</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Long QT Syndrome</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term>
<term>Long QT Syndrome</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Death, Sudden, Cardiac</term>
</keywords>
<keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Betacoronavirus</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Drug Monitoring</term>
<term>Electrocardiography</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Death, Sudden, Cardiac</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Hospitalization</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>COVID-19</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Outcome and Process Assessment, Health Care</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32439366</PMID>
<DateCompleted><Year>2020</Year>
<Month>09</Month>
<Day>15</Day>
</DateCompleted>
<DateRevised><Year>2021</Year>
<Month>01</Month>
<Day>10</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1874-1754</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>316</Volume>
<PubDate><Year>2020</Year>
<Month>10</Month>
<Day>01</Day>
</PubDate>
</JournalIssue>
<Title>International journal of cardiology</Title>
<ISOAbbreviation>Int J Cardiol</ISOAbbreviation>
</Journal>
<ArticleTitle>Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin.</ArticleTitle>
<Pagination><MedlinePgn>280-284</MedlinePgn>
</Pagination>
<ELocationID EIdType="pii" ValidYN="Y">S0167-5273(20)32223-3</ELocationID>
<ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ijcard.2020.05.036</ELocationID>
<Abstract><AbstractText Label="BACKGROUND">Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established.</AbstractText>
<AbstractText Label="METHODS">We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control.</AbstractText>
<AbstractText Label="RESULTS">Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability.</AbstractText>
<AbstractText Label="CONCLUSION">Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.</AbstractText>
<CopyrightInformation>Copyright © 2020 Elsevier B.V. All rights reserved.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cipriani</LastName>
<ForeName>Alberto</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy. Electronic address: alberto.cipriani@unipd.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zorzi</LastName>
<ForeName>Alessandro</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ceccato</LastName>
<ForeName>Davide</ForeName>
<Initials>D</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Capone</LastName>
<ForeName>Federico</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Parolin</LastName>
<ForeName>Matteo</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Donato</LastName>
<ForeName>Filippo</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Fioretto</LastName>
<ForeName>Paola</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Pesavento</LastName>
<ForeName>Raffaele</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Previato</LastName>
<ForeName>Lorenzo</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Padua Medical School, Padua, Italy.</Affiliation>
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Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin.

Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin.

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