Evidence map›Paper›PMID 32439366›Full record

ArticleInternational journal of cardiology2020

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

Alberto Cipriani, Alessandro Zorzi, Davide Ceccato, Federico Capone, Matteo Parolin, Filippo Donato, Paola Fioretto, Raffaele Pesavento, Lorenzo Previato, Pietro Maffei and 6 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 4 pooled it
9.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 4 syntheses or guidelines pooled it, 64 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Guideline
  5. Testing the feasibility of operationalizing a prospective, randomized trial with remote cardiac safety EKG monitoring during a pandemic.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2022
    Trial
  6. Trial
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  8. Review
  9. Article
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  13. Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2021
    Article
  14. Article
  15. COVID-19-Associated Cardiovascular Complications.Diseases (Basel, Switzerland) · 2021
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 1 institution in 1 country.

Alberto CiprianiDepartment of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy. Electronic address: alberto.cipriani@unipd.it.
Alessandro ZorziDepartment of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.
Davide CeccatoDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Federico CaponeDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Matteo ParolinDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Filippo DonatoDepartment of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.
Paola FiorettoDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Raffaele PesaventoDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Lorenzo PreviatoDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Pietro MaffeiDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Alois SallerDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Angelo AvogaroDepartment of Medicine, University of Padua Medical School, Padua, Italy.
Cristiano SaraisDepartment of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.
Dario GregoriDepartment of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.
Sabino IlicetoDepartment of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy.
Roberto VettorDepartment of Medicine, University of Padua Medical School, Padua, Italy.
University of Padua · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHydroxychloroquine 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.

methodsWe 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.

resultsOut 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.

conclusionTherapy 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.

Indexed as

AzithromycinHydroxychloroquineLong QT SyndromePandemicsAntiviral AgentsBetacoronavirusCoronavirus InfectionsCOVID-19Death, Sudden, CardiacDrug MonitoringElectrocardiographyFemaleHospitalizationHumansMaleMiddle AgedAntiviral AgentsAzithromycinHydroxychloroquineCoronavirusCOVID-19Severe acute respiratory syndromeSudden deathVentricular arrhythmia

Identifiers

PMID32439366
PMCPMC7235573
OpenAlexW3024653152

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.