Abstract
BACKGROUND: Previous research highlighted variability in electrocardiogram (ECG) readings across patient positions, particularly in the context of COVID-19 patients with pulmonary complications requiring prone positioning as part of the treatment. OBJECTIVE: This study aimed to elucidate the effects of prone positioning on ECG parameters and explore its association with the severity of COVID-19. METHODS: A prospective cohort study involved 60 patients diagnosed with COVID-19 and presenting pulmonary complications. ECGs were recorded in both supine and prone positions, and analyzed for various parameters including heart rate, QRS axis, and QTc interval. Clinical severity was assessed using APACHE II scores and SpO(2)/FiO(2) ratios. RESULTS: Prone positioning led to an increase in heart rate (mean difference: 2.100, 95% CI: 0.471-3.729, p = 0.012), with minor shifts in the QRS axis. Heart rate and QRS axis demonstrated strong positive correlations between positions, with Pearson's correlation coefficients of 0.927 and 0.894, respectively. The study also found a significant association between prolonged QTc intervals in the prone position and elevated APACHE II scores, with a relative risk of 10.75 (95% CI: 1.82-63.64, p = 0.008). CONCLUSIONS: The prone positioning caused minor yet significant changes in heart rate and QRS axis. The correlation of prolonged QTc intervals in the prone position with higher APACHE II scores suggests the prognostic relevance of prone ECG in COVID-19 patients. However, further research is needed to fully understand the clinical implications and mechanisms of these findings.