Electrocardiographic Risk Stratification in COVID-19 Patients

Ehud Chorin, Matthew Dai, Edward Kogan, Lalit Wadhwani, Eric Shulman, Charles Nadeau-Routhier, Robert Knotts, Roi Bar-Cohen, Chirag Barbhaiya, Anthony Aizer, Douglas Holmes, Scott Bernstein, Michael Spinelli, David Park, Larry Chinitz, Lior Jankelson

Research output: Contribution to journalArticlepeer-review


Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality. Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion. Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05–1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality. Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.

Original languageEnglish
Article number636073
JournalFrontiers in Cardiovascular Medicine
StatePublished - 2 Feb 2021
Externally publishedYes


  • COVID−19
  • ECG
  • mortality
  • predictors
  • troponin


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