Electrocardiographic QRS Axis Shift ,Rotation and COVİD-19
Electrocardiographic QRS Axis Shift ,Rotation and COVİD-19
In patients with coronavirus disease (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).

 This study investigated the predictability of advanced lung tomography findings with QRS axis
 shift and rotation.

 This was a retrospective analysis of 160 patients.The patients were divided into two groups:
 normal oxygen saturation(SpO2) (NS; n = 80) and low SpO2(LS;n = 80).They were then divided
 into NS Rws (n = 37), NS leftward shift (Lws; n = 43), LS Rws (n = 40), and LS Lws (n = 40)
 according to 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
The lung is the most seriously damaged organ in patients with coronavirus disease (COVID-19).
 In patients with advanced lung involvement, the alveoli are filled with fluid, white blood
 cells, mucus, and damaged lung cell debris [1].

 The electrical position of the heart in the frontal plane is defined as normal, right, left,
 or northwest quadrant axis deviation, while its position in the horizontal plane is defined
 as clockwise rotation (Cwr), normal transition, or counterclockwise rotation (Ccwr)[2].

 As respiratory disease progresses,rightward shift(Rws) of the frontal QRS axis can result
 from Cwr of the heart around its longitudinal axis as viewed from the apex, sudden increase
 in pulmonary vascular resistance causing right ventricle dilatation, or both [3].

 Electrocardiographic changes should be monitored intermittently, as this disease progresses
 rapidly to near 50% mortality within 7-28 days [4].The aim of this study was to investigate
 whether easily detectable electrocardiographic axis and rotation changes could predict
 advanced lung involvement[4].

 Methods Study design Records of 250 hospitalized patients with dyspnea and COVID-19 were
 analyzed retrospectively.Patients were excluded if they received positive pressurized oxygen
 therapy(n:25),underwent mechanical ventilation,(n:15)exhibited atrial fibrillation(n:10),
 conditions precluding the assessment of QRS transitional rotation ;complete bundle branch
 block(n:10), significant arrhythmias(n:5,complete atrioventricular block(n:2), polymorphic
 ventricular tachycardia(n:2), and ventricular fibrillation), Wolff-Parkinson-White
 syndrome(n:1), supraventricular tachycardia(n:4), or had unclear QRS axis orientation(n:20).
 The remaining160 patients who had electronic medical records, nursing records,at least three
 electrocardiographic recordings taken a few days apart, and laboratory and tomographic
 findings were included in the study.Patients with normal oxygen saturation (SpO2; ≥ 90%) who
 did not receive oxygen therapy and patients with low SpO2(<90%) who received nasal oxygen
 therapy were included in this study. Patients were divided into two groups: normal SpO2(NS,n
 = 80) and low SpO2(LS, n = 80).

 Electrocardiographic measurements were performed as previously described.The Tpe (T peak to T
 end) interval was measured from precordial leads [5].The delta corrected QT interval(QTc)
 calculated as last electrocardiographic QTc minus first electrocardiographic QTc.
 Discrepancies between computerized electrocardiographic analysis and the mean of three
 computer-aided measurements(Adobe Photoshop program-300dpi resolution) by a researcher were
 resolved by consultation with a second researcher.

 Using follow-up electrocardiography,according to the direction of QRS axis shift between the
 first and last electrocardiograms, both groups were divided into two main subgroups:patients
 with rightward shift (Rws) and patients with leftward shift(Lws) of the QRS axis.The patient
 numbers were as follows: NS Rws (n=37),NS Lws(n=43),LS Rws (n=40),andLS Lws (n=40). Based on
 electrocardiographic follow-up analyses,the two main groups were compared in terms of
 rotation condition (i.e., Cwr, normal transition, or CCwr), electrocardiographic intervals,
 and laboratory findings

 Tomographic findings were evaluated in accordance with COVID-19 Reporting and Data System
 (CO-RADS)classification.CO-RADS scores are as follows: 1 (very low level of suspicion), 2
 (low level of suspicion), 3 (equivocal), 4 (high level of suspicion),and 5 (very high level
 of suspicion)[6].
Inclusion Criteria:

 Hospitalized patients with dyspnea and COVID-19

 Exclusion Criteria:

 Patients who received positive pressurized oxygen therapy Patients who underwent mechanical
 ventilation, Atrial fibrillation Complete bundle branch block Significant
 arrhythmias(complete atrioventricular block, polymorphic ventricular tachycardia, and
 ventricular fibrillation), Wolff-Parkinson-White syndrome, supraventricular tachycardia
 Unclear QRS axis orientation.

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