We thank Murat and his colleagues (Murat et al., 2021) for their interest in our article. As highlighted, the main novelty of our paper is the prognostic role of serial ECG findings in a consecutive hospitalized population of patients with SARS-CoV-2-related pneumonia aiming to track the unfavorable course of patients with COVID-19 (Bergamaschi et al., 2021). We agree that our study had some differences when compared to other series (Angeli et al., 2020).

In particular, we enrolled consecutive a larger population of patients with laboratory-confirmed SARS-CoV-2 infection and radiological findings suggestive of interstitial pneumonia, including those requiring intensive care with a worsen disease and a higher rate of adverse events. We found that among patients with severe COVID-19, the ECG pathological abnormalities were more significant, as the ECG alterations after 7 days of hospitalization were more frequently associated with higher FiO2 needed (P-value <.001) and lower PaO2/FiO2 ratio (P-value <.001; Bergamaschi et al., 2021).

Our study was focused on the electrocardiographic alterations during the hospitalization of COVID-19 pneumonia regardless of the infection onset and independently of other factors such as an acute worsening of the disease. To reach such purpose, we have consecutively collected ECGs both at baseline and after 7 days of hospitalization. We believe that from a clinical point of view, this information at the beginning of hospitalization may be more useful to stratify the risk of major events rather than the general onset of infection which, as we know, can be misleading and therefore difficult to evaluate.

We agree that concomitant treatments and potential drug interactions can cause ECG changes. Meriglier et al. evaluated the safety of two antiviral drugs analyzing standard ECG obtained before starting treatment and up to 7 days in a small population of COVID-19 patients. They stated that 8 patients developed ECG abnormalities during the antiviral treatment, mainly repolarization disorders, and only 3 patients discontinued lopinavir/ritonavir compared with 4 that stopped darunavir/ritonavir due to the ECG alterations (Meriglier et al., 2021). At the beginning of the pandemic, in our hospital only lopinavir/ritonavir was administrated. We did not report these data in our work because these antiretroviral treatments were soon abandoned as standard therapy due to the lack of beneficial effects on the disease (Cao et al., 2020). On the other hand, 77.7% of patients in our population were treated with hydroxychloroquine at 7 days of hospitalization. Concerning the fear of major arrhythmia due to QTc interval prolongation, we report that only basal QTc interval was associated with major adverse events whereas the subsequent QTc measurements did not impact prognosis (Bergamaschi et al., 2021). Nevertheless, our data demonstrated no association between long QTc interval induced by hydroxychloroquine and ventricular arrhythmias remarking the cardiologic safety of this drug (Gasperetti et al., 2020).

After more than one year of this pandemic disease, the main challenge is still the lack of standardized treatments of COVID-19 pneumonia. In fact, only one antiviral drug (remdesivir) showed a clear benefit in shortening the time to recovery (Beigel et al., 2020). It appears crucial to treat the systemic inflammatory response and thrombotic complications triggered by SARS-COV2 infection (Marfella et al., 2020; Paolisso et al., 2020). More trials are certainly needed to adequately assess the cardiac injury induced by this complex infectious disease.

我们感谢Murat和他的同事（Murat等人，2021年）对我们的文章感兴趣。正如所强调的，我们论文的主要新颖之处在于连续住院的 SARS-CoV-2 相关肺炎患者的连续心电图结果对预后的作用，旨在追踪 COVID-19 患者的不利病程（Bergamaschi 等人，2017 年）。 ,  2021 )。我们同意，与其他系列相比，我们的研究存在一些差异（Angeli 等人，  2020 年）。

特别是，我们连续招募了大量实验室确诊的 SARS-CoV-2 感染和影像学检查结果提示间质性肺炎的患者，包括那些需要重症监护、病情恶化和不良事件发生率较高的患者。我们发现，在重症 COVID-19 患者中，心电图病理异常更为显着，因为住院 7 天后心电图的改变更常与更高的 FiO2 需要（P值 <.001）和更低的 PaO2/FiO2 比值相关（P值 <.001；Bergamaschi 等人，  2021 年）。

我们的研究侧重于 COVID-19 肺炎住院期间的心电图改变，无论感染发生如何，也与疾病的急性恶化等其他因素无关。为了达到这个目的，我们在基线和住院 7 天后连续收集了心电图。我们认为，从临床角度来看，住院开始时的这些信息可能更有助于对重大事件的风险进行分层，而不是一般感染的发生，正如我们所知，感染可能具有误导性，因此难以评估。

我们同意伴随治疗和潜在的药物相互作用会导致 ECG 变化。梅里格利尔等人。评估了两种抗病毒药物的安全性，分析了在开始治疗前和 7 天内在少数 COVID-19 患者中获得的标准心电图。他们指出，8 名患者在抗病毒治疗期间出现心电图异常，主要是复极障碍，只有 3 名患者停用洛匹那韦/利托那韦，而 4 名患者因心电图改变而停止使用达芦那韦/利托那韦（Meriglier 等，  2021）。大流行初期，我院仅使用洛匹那韦/利托那韦。我们没有在我们的工作中报告这些数据，因为由于缺乏对疾病的有益作用，这些抗逆转录病毒治疗很快被放弃作为标准治疗（Cao 等，  2020）。另一方面，我们人群中 77.7% 的患者在住院 7 天时接受了羟氯喹治疗。关于因 QTc 间期延长而导致严重心律失常的恐惧，我们报告说，只有基础 QTc 间期与主要不良事件相关，而随后的 QTc 测量并未影响预后（Bergamaschi 等人，  2021 年））。尽管如此，我们的数据表明羟氯喹诱导的长 QTc 间期与室性心律失常之间没有关联，这表明该药物的心脏安全性（Gasperetti 等，  2020）。

在这种大流行病一年多之后，主要挑战仍然是缺乏对 COVID-19 肺炎的标准化治疗。事实上，只有一种抗病毒药物（瑞德西韦）在缩短恢复时间方面表现出明显的优势（Beigel 等人，  2020 年）。治疗由 SARS-COV2 感染引发的全身炎症反应和血栓并发症似乎至关重要（Marfella 等人，  2020 年；Paolisso 等人，  2020 年）。当然需要更多的试验来充分评估这种复杂的传染病引起的心脏损伤。