T-wave Peak-to-End Changes Quantified by Time-Warping Predicts Ventricular Fibrillation in a Porcine Myocardial Infarction Model
(2024) In IEEE Transactions on Biomedical Engineering p.1-10- Abstract
<italic>Background:</italic> The T-peak-to-T-end (<inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula>) interval has shown potential in predicting ventricular arrhythmic risk. It is an appealing index to be measured during ischemia since it is less influenced by ST-segment changes than the early part of the T wave. A time-warping-based index, derived from a spatially transformed PCA lead, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula>, quantifying changes in the <inline-formula><tex-math... (More)
<italic>Background:</italic> The T-peak-to-T-end (<inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula>) interval has shown potential in predicting ventricular arrhythmic risk. It is an appealing index to be measured during ischemia since it is less influenced by ST-segment changes than the early part of the T wave. A time-warping-based index, derived from a spatially transformed PCA lead, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula>, quantifying changes in the <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula> morphology, has previously demonstrated utility in tracking repolarization changes induced by a 5-minute ischemia model in humans. The value of <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> as a predictor of ventricular fibrillation (VF) episodes is assessed in a porcine model of myocardial ischemia with ischemia maintained for 40 minutes. <italic>Methods:</italic> From 32 pigs undergoing a coronary occlusion, pre-occlusion and occlusion ECG recordings from 10 pigs suffering a VF episode after 10 min of occlusion (Delayed VF) and 16 that did not had any episode during the recording were analyzed. The <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> series was measured by comparing <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula> morphologies at different stages of the occlusion relative to the peak-to-end morphology of a baseline T-wave. <italic>Results:</italic> During baseline, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> remained stationary with an intra-recording median [IQR] value of 1.60 [1.33] ms. During artery occlusion, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> followed a well-marked gradual increasing trend as ischemia progressed, reaching a median of 14.58 [17.72] ms. <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> averages were significantly higher (<inline-formula><tex-math notation="LaTeX">${p< 0.05}$</tex-math></inline-formula>) in the VF group than in the Non-VF group at time intervals 0-5, 5-10, 10-15, 15-20, 20-25 min after occlusion onset and at 10-15, 5-10 and 5-0 minutes prior to VF episode, with median values of 12.5, 18.8, 26.8, 24.0, 31.0, 18.6, 25.0 and 28.8 vs 6.3, 7.6, 8.0, 7.8, 7.8, 8.5, 7.2 and 6.0 ms, respectively. The <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula> interval was also significantly higher in the VF group at all analyzed time periods, but with a lower significance level. Pigs with maximum <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> <inline-formula><tex-math notation="LaTeX">$\geq$</tex-math></inline-formula> 20.0 ms and <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula> <inline-formula><tex-math notation="LaTeX">$\geq$</tex-math></inline-formula> 85.4 ms had significantly higher risk for VF occurring in the early 5-10 minutes interval, with 90.0%/75.0% and 80.0%/69.0% sensitivity/specificity, respectively. Univariate Cox analysis yielded hazard ratios of 12.5 for <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> vs 5.5 for <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula>. <italic>Conclusions and Significance:</italic> The time-warping-based index, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula>, is a stronger VF predictor than <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula> during ischemia in a porcine model, advising for further clinical exploration studies in humans.
(Less)
- author
- Gomez, Neurys ; Ramirez, Julia ; Martin-Yebra, Alba ; Demidova, Marina M. LU ; Platonov, Pyotr LU ; Martinez, Juan Pablo and Laguna, Pablo
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- in press
- subject
- keywords
- Electrocardiogram, ischemia, repolarization, T-peak to T-end interval, T-wave morphology, time warping, ventricular arrhythmias
- in
- IEEE Transactions on Biomedical Engineering
- pages
- 10 pages
- publisher
- IEEE - Institute of Electrical and Electronics Engineers Inc.
- external identifiers
-
- scopus:85194063059
- pmid:38776194
- ISSN
- 0018-9294
- DOI
- 10.1109/TBME.2024.3404254
- language
- English
- LU publication?
- yes
- id
- c49a67e4-66fe-47f9-9726-708666d8c907
- date added to LUP
- 2024-06-13 15:16:20
- date last changed
- 2024-06-13 15:17:23
@article{c49a67e4-66fe-47f9-9726-708666d8c907,
abstract = {{<p><italic>Background:</italic> The T-peak-to-T-end (<inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula>) interval has shown potential in predicting ventricular arrhythmic risk. It is an appealing index to be measured during ischemia since it is less influenced by ST-segment changes than the early part of the T wave. A time-warping-based index, derived from a spatially transformed PCA lead, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula>, quantifying changes in the <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula> morphology, has previously demonstrated utility in tracking repolarization changes induced by a 5-minute ischemia model in humans. The value of <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> as a predictor of ventricular fibrillation (VF) episodes is assessed in a porcine model of myocardial ischemia with ischemia maintained for 40 minutes. <italic>Methods:</italic> From 32 pigs undergoing a coronary occlusion, pre-occlusion and occlusion ECG recordings from 10 pigs suffering a VF episode after 10 min of occlusion (Delayed VF) and 16 that did not had any episode during the recording were analyzed. The <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> series was measured by comparing <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}$</tex-math></inline-formula> morphologies at different stages of the occlusion relative to the peak-to-end morphology of a baseline T-wave. <italic>Results:</italic> During baseline, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> remained stationary with an intra-recording median [IQR] value of 1.60 [1.33] ms. During artery occlusion, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> followed a well-marked gradual increasing trend as ischemia progressed, reaching a median of 14.58 [17.72] ms. <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> averages were significantly higher (<inline-formula><tex-math notation="LaTeX">${p&lt; 0.05}$</tex-math></inline-formula>) in the VF group than in the Non-VF group at time intervals 0-5, 5-10, 10-15, 15-20, 20-25 min after occlusion onset and at 10-15, 5-10 and 5-0 minutes prior to VF episode, with median values of 12.5, 18.8, 26.8, 24.0, 31.0, 18.6, 25.0 and 28.8 vs 6.3, 7.6, 8.0, 7.8, 7.8, 8.5, 7.2 and 6.0 ms, respectively. The <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula> interval was also significantly higher in the VF group at all analyzed time periods, but with a lower significance level. Pigs with maximum <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> <inline-formula><tex-math notation="LaTeX">$\geq$</tex-math></inline-formula> 20.0 ms and <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula> <inline-formula><tex-math notation="LaTeX">$\geq$</tex-math></inline-formula> 85.4 ms had significantly higher risk for VF occurring in the early 5-10 minutes interval, with 90.0&#x0025;/75.0&#x0025; and 80.0&#x0025;/69.0&#x0025; sensitivity/specificity, respectively. Univariate Cox analysis yielded hazard ratios of 12.5 for <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula> vs 5.5 for <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula>. <italic>Conclusions and Significance:</italic> The time-warping-based index, <inline-formula><tex-math notation="LaTeX">$d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$</tex-math></inline-formula>, is a stronger VF predictor than <inline-formula><tex-math notation="LaTeX">$\mathrm{T}_{pe}^{\text{PCA}}$</tex-math></inline-formula> during ischemia in a porcine model, advising for further clinical exploration studies in humans.</p>}},
author = {{Gomez, Neurys and Ramirez, Julia and Martin-Yebra, Alba and Demidova, Marina M. and Platonov, Pyotr and Martinez, Juan Pablo and Laguna, Pablo}},
issn = {{0018-9294}},
keywords = {{Electrocardiogram; ischemia; repolarization; T-peak to T-end interval; T-wave morphology; time warping; ventricular arrhythmias}},
language = {{eng}},
pages = {{1--10}},
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 Predicts Ventricular Fibrillation in a Porcine Myocardial Infarction Model}},
url = {{http://dx.doi.org/10.1109/TBME.2024.3404254}},
doi = {{10.1109/TBME.2024.3404254}},
year = {{2024}},
}