Digital DiagnosticsDigital DiagnosticsDigital DiagnosticsDigital Diagnostics2712-84902712-8962Eco-Vector7188510.17816/DD71885Original Study ArticlesОригинальные исследования原创性科研成果Research ArticleElectrocardiographic findings in COVID-19: analysis of tele-ECGs in Moscow ECG IT CenterЭлектрокардиографические феномены при COVID-19: анализ теле-ЭКГ-исследований IT-центра ЭКГ г. МосквыCovid-19的心电图现象：莫斯科IT中心电视心电图研究的分析https://orcid.org/0000-0003-4452-76676314-8190TaskinaVarvara Y.ТаскинаВарвара ЮрьевнаTaskinaVarvara Y.
Russian Federation

MD, Cand. Sci. (Med.), Researcher, Telemedicine Research Projects Sector

кандидат медицинских наук, научный сотрудник сектора научных проектов по телемедицине

MD, Cand. Sci. (Med.), Researcher, Telemedicine Research Projects Sector

varvara.taskina@gmail.comhttps://orcid.org/0000-0001-8004-97254657-5501DemkinaAlexandra E.ДемкинаАлександра ЕвгеньевнаDemkinaAlexandra E.
Russian Federation

MD, Cand. Sci. (Med.), Head of the Telemedicine Research Projects Sector

кандидат медицинских наук, начальник сектора научных проектов по телемедицине

MD, Cand. Sci. (Med.), Head of the Telemedicine Research Projects Sector

a.demkina@npcmr.ruhttps://orcid.org/0000-0002-5875-96994208-2303GazashviliTamara M.ГазашвилиТамара МихайловнаGazashviliTamara M.
Russian Federation

MD, Head of the Center for Diagnostic Investigations

руководитель центра инструментальной диагностики

MD, Head of the Center for Diagnostic Investigations

tamaradoc24@gmail.comhttps://orcid.org/0000-0002-9783-17964520-2141ShkodaAndrey S.ШкодаАндрей СергеевичShkodaAndrey S.
Russian Federation

MD, Dr. Sci. (Med.), Professor, Chief Physician

доктор медицинских наук, профессор, главный врач

MD, Dr. Sci. (Med.), Professor, Chief Physician

a.shkoda@67gkb.ruhttps://orcid.org/0000-0002-2990-77363602-7120VladzymyrskyyAnton V.ВладзимирскийАнтон ВячеславовичVladzymyrskyyAnton V.
Russian Federation

MD, Dr. Sci. (Med.), Deputy Director for Science; professor of the Department of Information and Internet Technologies

доктор медицинских наук, заместитель директора по науке; профессор кафедры информационных и интернет-технологий

MD, Dr. Sci. (Med.), Deputy Director for Science; professor of the Department of Information and Internet Technologies

a.vladzimirsky@npcmr.ruhttps://orcid.org/0000-0001-6545-61708542-1720MorozovSergey P.МорозовСергей ПавловичMorozovSergey P.
Russian Federation

MD, Dr. Sci. (Med.), Professor

доктор медицинских наук, профессор, директор

MD, Dr. Sci. (Med.), Professor

morozov@npcmr.ruResearch and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare DepartmentНаучно-практический клинический центр диагностики и телемедицинских технологий Департамента здравоохранения города МосквыResearch and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare DepartmentL.A. Vorokhobov City Clinical Hospital No. 67 of the Moscow Healthcare DepartmentГородская клиническая больница № 67 имени Л.А. Ворохобова Департамента здравоохранения города МосквыL.A. Vorokhobov City Clinical Hospital No. 67 of the Moscow Healthcare DepartmentMoscow Center for Diagnostics and TelemedicineНаучно-практический клинический центр диагностики и телемедицинских технологий Департамента здравоохранения г. МосквыMoscow Center for Diagnostics and TelemedicineThe First Sechenov Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)The First Sechenov Moscow State Medical University (Sechenov University)2709202115102021232352482106202121092021Copyright ©; 2021, Taskina V.Y., Demkina A.E., Gazashvili T.M., Shkoda A.S., Vladzymyrskyy A.V., Morozov S.P.Copyright ©; 2021, Таскина В.Ю., Демкина А.Е., Газашвили Т.М., Шкода А.С., Владзимирский А.В., Морозов С.П.Copyright ©; 2021, Taskina V.Y., Demkina A.E., Gazashvili T.M., Shkoda A.S., Vladzymyrskyy A.V., Morozov S.P.2021Taskina V.Y., Demkina A.E., Gazashvili T.M., Shkoda A.S., Vladzymyrskyy A.V., Morozov S.P.Таскина В.Ю., Демкина А.Е., Газашвили Т.М., Шкода А.С., Владзимирский А.В., Морозов С.П.Taskina V.Y., Demkina A.E., Gazashvili T.M., Shkoda A.S., Vladzymyrskyy A.V., Morozov S.P.https://creativecommons.org/licenses/by-nc-nd/4.0https://jdigitaldiagnostics.com/DD/article/view/71885

BACKGROUND: Coronavirus disease (COVID-19) affects the cardiovascular system and the primary damage to the respiratory system involved in the pathological process. However, in the available literature, the electrocardiography (ECG) analyses are based only on small-sample studies and case reports, which determine the relevance of larger-scale studies to clarify the nature and prevalence of ECG abnormalities in subjects with confirmed coronavirus infection.

AIM: To determine the distribution of ECG changes in COVID-19 patients representing a non-selective population of Moscow residents.

MATERIALS AND METHODS: We performed a retrospective analysis of ECGs from 42,799 patients from March 10, 2020 to March 10, 2021 with a verified diagnosis of COVID-19 was performed. The study included patients admitted to Moscow clinical hospitals connected to the ECG IT Center. A standard 12-lead ECG was obtained and transmitted via an Internet connection to the server of the ECG IT Center, where the ECG interpretation was performed.

RESULTS: ECG changes were detected in 54% of patients. The most common cardiac arrhythmias were supraventricular extrasystole (12.6%) and atrial fibrillation (12.0%) reported in patients. Signs of the overloaded right heart were detected in 12.5% of cases, of which the ECG pattern of pulmonary embolism was confirmed in 485 patients (1.13%). Infarction ECG pattern was observed in 4.5% of patients, among which 3 cases of Brugada ECG pattern were reported. The incidence of ST-T changes was 2.2% of all study patients. Prolonged QT and QTc intervals were recorded in 540 patients (1.26%). In addition, individual cases of ventricular fibrillation, Frederick syndrome, and atrioventricular block of various degrees were reported.

CONCLUSION: The distribution of incidence of ECG changes in COVID-19 was shown based on the data obtained. The high incidence of atrial fibrillation, which is a risk factor for thromboembolic complications, was confirmed. Moreover, a significant prevalence of ECG patterns of overloaded right heart was shown, some are associated with pulmonary embolism. Other reported ECG changes were characterized by a significantly lower prevalence, which does not reduce their clinical significance. The data obtained may be used to improve COVID-19 patient management strategy in the future.

Обоснование. При новой коронавирусной инфекции (COVID-19) наряду с доминирующим поражением органов дыхания в патологический процесс вовлекается сердечно-сосудистая система. Однако в доступной литературе аналитические оценки электрокардиографических (ЭКГ) феноменов опираются лишь на результаты исследований небольших выборок и описания единичных клинических случаев, что определяет актуальность проведения более масштабных исследований для уточнения характера и распространённости ЭКГ-изменений у лиц с подтверждённой коронавирусной инфекцией.

Цель ― структуризация изменений ЭКГ у пациентов с COVID-19, представляющих неселективную популяцию жителей г. Москвы.

Материалы и методы. Проведён ретроспективный анализ электрокардиографических исследований, выполненных у 42 799 пациентов с верифицированным диагнозом COVID-19 в период с 10.03.2020 по 10.03.2021. Все включённые в исследование лица проходили стационарное лечение в клинических больницах г. Москвы, подключённых к IT-центру ЭКГ. Регистрация ЭКГ производилась в 12 стандартных отведениях, после чего путём интернет-соединения информация передавалась на сервер IT-центра ЭКГ с целью формулировки соответствующих заключений.

Результаты. Изменения ЭКГ обнаружены у 54% пациентов. Наиболее частыми аритмиями были наджелудочковая экстрасистолия и фибрилляция предсердий ― у 12,6 и 12,0% пациентов соответственно. Признаки перегрузки правых отделов сердца выявлены у 12,5% больных, из них в 1,13% случаев ― ЭКГ-паттерн тромбоэмболии лёгочной артерии. Инфарктоподобные изменения на ЭКГ имели место у 4,5% субъектов, в том числе 3 случая паттерна Бругада. Частота встречаемости изменений ST-T составила 2,2% от числа всех исследований. ЭКГ с удлинённым интервалом QT и QTc зарегистрирована у 540 (1,26%) пациентов. Отмечены единичные случаи фибрилляции желудочков, синдрома Фредерика и АВ-блокады различной степени.

Заключение. На основе проведённого анализа получено представление о частоте встречаемости электрокардиографических феноменов у больных COVID-19. Подтверждена высокая инцидентность фибрилляции предсердий ― фактора риска тромбоэмболических осложнений. Одновременно установлена значительная распространённость ЭКГ-паттернов перегрузки правых отделов сердца, часть из которых ассоциирована с тромбоэмболией лёгочной артерии. Другие наблюдаемые изменения ЭКГ характеризовались значительно меньшей распространённостью, что, однако, не снижает их клинического значения. Собранный материал в перспективе может служить оптимизации тактики ведения пациентов при коронавирусной инфекции.

论证通过新的冠状病毒感染（Covid-19），随着病理过程中呼吸器官的主要损伤，涉及一种心血管系统。然而，在可用文献中，心电图（ECG）现象的分析估计是基于对小样本的研究结果和单一临床病例的描述，这决定了开展更多大规模研究以澄清性质和患病率的相关性ECG改变冠状病毒感染的人。

目标是构建Covid-19患者ECG的变化，代表莫斯科居民的非选择性人口。

材料与方法心电图研究的回顾性分析，42,799名患者在10.03.2020至10.03.2021期间验证了Covid-19验证诊断。 所有包括在研究人员中的所有人都在莫斯科的临床医院通过住院治疗，连接到ECG IT中心。 12根标准导联上进行ECG登记， 然后，通过互联网连接，将信息传输到ECG IT中心服务器，以形成相关结论。

结果。54％的患者中检测到ECG变化。最常见的心律失常是心室外收缩和心房颤动，分别占12.6%和12.0%。12.5%的患者表现出右心室过载的迹象，其中1.13%的患者表现出肺动脉血栓栓塞的心电图模式。 心电图梗死样改变发生在4.5%的受试者中，包括3例Brugada型。 ST-T发生变化的发生频率为所有研究的数量的2.2％。 带有细长QT和QTC间隔的ECG在540（1.26％）患者中注册。 报告了不同程度的心室颤动，弗雷德里克综合征和AB阻滞的单位病例.

结论。基于分析，获得了Covid-19患者心电图现象的发生频率的思路。 确认心房颤动的高发病率 - 血栓栓塞并发症的危险因素。 与此同时，建立了右侧心脏部门过载的ECG模式的显着普遍性，其中一些与光动脉的血栓栓塞相关。 其他观察到的ECG变化的特征在于显着较差的患病率，然而，这不会降低其临床意义。 未来的收集材料可以是冠状病毒感染的患者管理策略的优化。

electrocardiographyCOVID-19cardiovascular diseasesarrhythmiasmyocarditispulmonary embolismtele-ECGэлектрокардиографияCOVID-19сердечно-сосудистые заболеванияаритмиимиокардиттромбоэмболия лёгочной артерииТЭЛАтеле-ЭКГ心电图新冠肺炎心血管疾病心律失常心肌炎肺栓塞tele - 远程心电图This paper was prepared by a group of authors as part of research (No. in the Unified State Information System for Accounting of Research, Development, and Technological Works (EGISU): АААА-А20-120071090050-1) under the Program of the Moscow Healthcare Department “Scientific Support of the Capital's Healthcare” for 2020–2022Данная статья подготовлена авторским коллективом в рамках научно-исследовательской работы (№ ЕГИСУ: АААА-А20-120071090050-1) в соответствии с Программой Департамента здравоохранения города Москвы «Научное обеспечение столичного здравоохранения» на 2020-2022 годаWu Z, McGoogan JM. 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