T-wave inversion as a manifestation of COVID-19 infection: a case series

Jorge E. Romero, Isabella Alviz, Michael K. Parides, Juan Carlos Diaz, David F. Briceno Gomez, Mohamed Gabr, Maria Gamero, Kavisha Patel, Eric D. Braunstein, Sutopa Purkayastha, Dalvert Polanco, Carolina R. Valencia, Domenico Della Rocca, Alejandro Velasco, Ruike Yang, Nicola Tarantino, Xiao Dong Zhang, Sanghamitra Mohanty, Juan Bello, Andrea NataleUlrich P. Jorde, Mario Garcia, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Purpose: Cardiac involvement with COVID-19 infection has become evident by elevated troponin, cardiac arrhythmias, ST segment elevation, myocarditis, fulminant heart failure, and sudden cardiac death. We aimed to describe the association of COVID-19 and T-wave inversion (TWI) in a large case series. Methods: We conducted an observational, retrospective study of confirmed COVID-19 cases with at least one electrocardiogram (ECG) in a large hospital in New York City (March 23, 2020–April 23, 2020). Patients with new TWI or pseudonormalization were further analyzed. Mortality and the need for invasive mechanical ventilation were the main outcomes. Results: A total of 3225 patients were screened; 195 (6%) were selected for further analysis: 181 with TWI and 14 with T-wave pseudonormalization. Mean age was 66 ± 7 years; 51% were male. TWI were more commonly noted in the lateral (71%), followed by anterior (64%), inferior (57%), and septal (26%) leads. A total of 44 patients (23%) had elevated troponin. A total of 50 patients died (26%). Mortality rates of 35%, and 52% were observed in patients with diffuse TWI, and elevated troponin, respectively. Mortality rate of 80% was observed in patients with both elevated troponin and diffuse TWI. Additionally, 30% of the entire cohort and 58% of patients with elevated troponin required invasive mechanical ventilation. Conclusion: Our study demonstrates that new TWI is a relatively common finding in COVID-19 patients. Importantly, our findings suggest that new TWI or T-wave pseudonormalization, particularly with elevated troponin, was associated with higher rates of mechanical ventilation and in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)485-493
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Issue number3
StatePublished - Dec 2020


  • COVID 19
  • ECG abnormality
  • Mortality
  • T-wave inversion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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