T-wave Peak-to-End Changes, Quantified by Time-Warping, Surrogates Ventricular Repolarization Dispersion for Ventricular Fibrillation Prediction in a Porcine Myocardial Infarction Model
(2026) In IEEE Transactions on Biomedical Engineering- Abstract
Background: Ventricular fibrillation (VF) during acute ischemia is linked to increased dispersion of ventricular repolarization (DOR), which is considered a robust marker of arrhythmic susceptibility. In previous works, we showed that a time-warping-based index quantifying morphological changes from the T-wave peak to the T-wave end over a PCA transform lead, dPCAw,Tpe, outperformed the T-peak-to-T-end interval (Tpe) in arrhythmic risk prediction in a closed-chest porcine infarction model. In this study, we compare dPCAw,Tpe with the DOR measured in an open-chest porcine infarction model, to test the hypothesis that dPCAw,Tpe is a noninvasive surrogate for DOR,... (More)
Background: Ventricular fibrillation (VF) during acute ischemia is linked to increased dispersion of ventricular repolarization (DOR), which is considered a robust marker of arrhythmic susceptibility. In previous works, we showed that a time-warping-based index quantifying morphological changes from the T-wave peak to the T-wave end over a PCA transform lead, dPCAw,Tpe, outperformed the T-peak-to-T-end interval (Tpe) in arrhythmic risk prediction in a closed-chest porcine infarction model. In this study, we compare dPCAw,Tpe with the DOR measured in an open-chest porcine infarction model, to test the hypothesis that dPCAw,Tpe is a noninvasive surrogate for DOR, investigating its predictive value for VF occurrence. Methods: Myocardial ischemia was induced by coronary ligation in 55 domestic pigs. Surface ECG and intramyocardial electrograms were recorded simultaneously. DOR was computed as the range of the end-of-repolarization times across intramyocardial electrograms, while dPCAw,Tpe was extracted from Tpe morphology, measured in a spatially transformed PCA lead and using a warping-based approach. Additionally, the classical Tpe interval was computed as a reference. Indices were compared between pigs developing delayed VF (Delayed-VF group) and those who did not (Non-VF group). Results: dPCAw,Tpe, DOR and Tpe remained stable at baseline but showed progressive changes during ischemia, with larger changes in animals that developed VF. At 5, 10, and 15 minutes after occlusion, ROC analysis showed significant discriminatory capacity, with AUC values consistently ≥0.79 for all indexes and an early predictive value with AUC of 0.870 for dPCAw,Tpe at 5 minutes, accompanied by balanced sensitivity and specificity values. Cox regression for VF risk prediction resulted in hazard ratios ranging from 5.86 to 11.95 across time points. Kaplan-Meier survival curves stratified by ROC-derived thresholds showed significant separation between groups at all three time points. Linear regression analyses between dPCAw,Tpe and DOR showed consistent correlation in VF-susceptible animals (median R2=0.33). This association was stronger than that observed between Tpe and DOR (median R2=0.16). Conclusions: The time-warping-based index, dPCAw,Tpe, is a reliable non-invasive surrogate of DOR, with comparable predictive value for delayed VF risk under ischemic conditions, providing earlier and more robust prediction than the Tpe index. These findings highlight their translational potential and require validation in human cohort studies.
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- author
- Gómez, Neurys ; Abramochkina, Alena S. ; Ramirez, Julia ; Ovechkin, Alexey O. ; Bernikova, Olesya G. ; Platonov, Pyotr G. LU ; Azarov, Jan E. ; Laguna, Pablo and Martínez, Juan Pablo
- organization
- publishing date
- 2026
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- dispersion of repolarization, ischemia, T-peak-to-T-end interval, T-wave morphology, time-warping, ventricular fibrillation
- in
- IEEE Transactions on Biomedical Engineering
- publisher
- IEEE - Institute of Electrical and Electronics Engineers Inc.
- external identifiers
-
- pmid:41979954
- scopus:105036878017
- ISSN
- 0018-9294
- DOI
- 10.1109/TBME.2026.3683284
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 1964-2012 IEEE.
- id
- 07437d4c-c816-4818-a861-dd76f5602aa1
- date added to LUP
- 2026-06-26 14:48:30
- date last changed
- 2026-06-26 14:49:38
@article{07437d4c-c816-4818-a861-dd76f5602aa1,
abstract = {{<p>Background: Ventricular fibrillation (VF) during acute ischemia is linked to increased dispersion of ventricular repolarization (DOR), which is considered a robust marker of arrhythmic susceptibility. In previous works, we showed that a time-warping-based index quantifying morphological changes from the T-wave peak to the T-wave end over a PCA transform lead, d<sup>PCA</sup><sub>w,Tpe</sub>, outperformed the T-peak-to-T-end interval (T<sub>pe</sub>) in arrhythmic risk prediction in a closed-chest porcine infarction model. In this study, we compare d<sup>PCA</sup><sub>w,Tpe</sub> with the DOR measured in an open-chest porcine infarction model, to test the hypothesis that d<sup>PCA</sup><sub>w,Tpe</sub> is a noninvasive surrogate for DOR, investigating its predictive value for VF occurrence. Methods: Myocardial ischemia was induced by coronary ligation in 55 domestic pigs. Surface ECG and intramyocardial electrograms were recorded simultaneously. DOR was computed as the range of the end-of-repolarization times across intramyocardial electrograms, while d<sup>PCA</sup><sub>w,Tpe</sub> was extracted from T<sub>pe</sub> morphology, measured in a spatially transformed PCA lead and using a warping-based approach. Additionally, the classical T<sub>pe</sub> interval was computed as a reference. Indices were compared between pigs developing delayed VF (Delayed-VF group) and those who did not (Non-VF group). Results: d<sup>PCA</sup><sub>w,Tpe</sub>, DOR and T<sub>pe</sub> remained stable at baseline but showed progressive changes during ischemia, with larger changes in animals that developed VF. At 5, 10, and 15 minutes after occlusion, ROC analysis showed significant discriminatory capacity, with AUC values consistently ≥0.79 for all indexes and an early predictive value with AUC of 0.870 for d<sup>PCA</sup><sub>w,Tpe</sub> at 5 minutes, accompanied by balanced sensitivity and specificity values. Cox regression for VF risk prediction resulted in hazard ratios ranging from 5.86 to 11.95 across time points. Kaplan-Meier survival curves stratified by ROC-derived thresholds showed significant separation between groups at all three time points. Linear regression analyses between d<sup>PCA</sup><sub>w,Tpe</sub> and DOR showed consistent correlation in VF-susceptible animals (median R<sup>2</sup>=0.33). This association was stronger than that observed between T<sub>pe</sub> and DOR (median R<sup>2</sup>=0.16). Conclusions: The time-warping-based index, d<sup>PCA</sup><sub>w,Tpe</sub>, is a reliable non-invasive surrogate of DOR, with comparable predictive value for delayed VF risk under ischemic conditions, providing earlier and more robust prediction than the T<sub>pe</sub> index. These findings highlight their translational potential and require validation in human cohort studies.</p>}},
author = {{Gómez, Neurys and Abramochkina, Alena S. and Ramirez, Julia and Ovechkin, Alexey O. and Bernikova, Olesya G. and Platonov, Pyotr G. and Azarov, Jan E. and Laguna, Pablo and Martínez, Juan Pablo}},
issn = {{0018-9294}},
keywords = {{dispersion of repolarization; ischemia; T-peak-to-T-end interval; T-wave morphology; time-warping; ventricular fibrillation}},
language = {{eng}},
publisher = {{IEEE - Institute of Electrical and Electronics Engineers Inc.}},
series = {{IEEE Transactions on Biomedical Engineering}},
title = {{T-wave Peak-to-End Changes, Quantified by Time-Warping, Surrogates Ventricular Repolarization Dispersion for Ventricular Fibrillation Prediction in a Porcine Myocardial Infarction Model}},
url = {{http://dx.doi.org/10.1109/TBME.2026.3683284}},
doi = {{10.1109/TBME.2026.3683284}},
year = {{2026}},
}