We have read with great interest the article “The value of ECG changes in risk stratification of COVID-19 patients” by Bergamaschi et al. (2021). In this study, it was stated that ECG alterations at admission and follow-up period could help clinicians stratify the risk of major adverse events in COVID-19. The importance of serial ECG evaluations in hospitalized patients with COVID-19 is emphasized. Here, we would like to discuss about the results of this study.

Despite the importance of the role of ECG in the diagnosis of cardiovascular complications during COVID-19 disease, there is a lack of knowledge about ECG features and ECG changes during hospitalization due to COVID-19.

In a study which conducted by Angeli et al. (2020), included 50 patients who admitted to hospital with proven COVID-19 pneumonia. ECG was recorded at discharge and in case of worsening clinical conditions. The study showed that ECG abnormalities showed a late onset from hospitalization and initiation of COVID-19 symptoms. They reported that the meantime for development of ECG abnormalities was 20 and 30 days from admission and onset of symptoms, respectively, and that the majority of patients (54%) experienced ECG abnormalities just before the scheduled discharge and after 2 consecutive negative nasopharyngeal swabs. While Bergamaschi et al. examined the ECG records of the patients at admission and 7 days of hospitalization in their study, they did not provide information about the onset of symptoms and the time of diagnosis. We think that knowing the onset time of the patients' COVID-19 symptoms, the duration of hospitalization, the ECG features taken in case of clinical deterioration and before discharge, and severity of illness may be even more beneficial in terms of interpreting the results.

Also, concomitant treatments and potential drug interactions can cause ECG changes. In the present study, no information was given about antiretroviral drugs used in the treatment of COVID-19 and concomitant antiarrhythmic medications. However, Meriglier et al. emphasized that 17% of COVID-19 patients receiving hydroxychloroquine with lopinavir or darunavir had ECG abnormalities (Meriglier et al., 2021).

Nevertheless, this study is valuable in drawing attention to ECG monitoring in COVID-19 patients during their hospital stay. More trials are needed that take into account the points we have mentioned about ECG features in COVID-19 patients.

我们非常感兴趣地阅读了 Bergamaschi 等人的文章“心电图变化在 COVID-19 患者风险分层中的价值”。（2021 年）。在这项研究中，指出入院和随访期间的心电图改变可以帮助临床医生对 COVID-19 中主要不良事件的风险进行分层。强调了对住院 COVID-19 患者进行连续心电图评估的重要性。在这里，我们想讨论一下这项研究的结果。

尽管心电图在 COVID-19 疾病期间诊断心血管并发症中的作用很重要，但仍缺乏关于因 COVID-19 住院期间心电图特征和心电图变化的知识。

在 Angeli 等人进行的一项研究中。( 2020)，包括 50 名因确诊 COVID-19 肺炎入院的患者。在出院时和临床状况恶化的情况下记录心电图。该研究表明，心电图异常显示出住院和 COVID-19 症状出现较晚。他们报告说，发生心电图异常的时间分别是入院和出现症状的 20 天和 30 天，大多数患者 (54%) 在计划出院前和连续 2 次鼻咽拭子阴性后出现心电图异常。虽然 Bergamaschi 等人。在研究中检查了入院和住院7天患者的ECG记录，他们没有提供有关症状发作和诊断时间的信息。我们认为，了解患者的发病时间

同样，伴随的治疗和潜在的药物相互作用也可能导致心电图改变。在本研究中，没有提供有关用于治疗 COVID-19 的抗逆转录病毒药物和伴随的抗心律失常药物的信息。然而，Meriglier 等人。强调接受羟氯喹和洛匹那韦或达芦那韦的 COVID-19 患者中有 17% 有心电图异常（Meriglier 等人，  2021 年）。

但是，这项研究对于吸引COVID-19患者住院期间的ECG监测非常有价值。需要更多的试验来考虑我们提到的 COVID-19 患者心电图特征的要点。