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Evaluation of ventricular repolarization dispersion during acute myocardial ischemia: spatial and temporal ECG indices

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Abstract

In this work, we studied the evolution of different electrocardiogram (ECG) indices of ventricular repolarization dispersion (VRD) during acute transmural myocardial ischemia in 95 patients undergoing percutaneous coronary intervention (PCI). We studied both temporal indices of VRD (T-VRD), based on the time intervals of the ECG wave, and spatial indices of VRD (S-VRD), based on the eigenvalues of the spatial correlation matrix of the ECG. The T-wave peak-to-end interval I TPE index showed statistically significant differences during left anterior descending artery and right coronary artery (RCA) occlusion for almost the complete time course of the PCI procedure with respect to the control recording. Regarding S-VRD indices, we observed statistically significant increases in the ratio of second to the first eigenvalue I T21, the ratio of the third to the first eigenvalue I T31 and the T-wave residuum I TWR during RCA occlusions. We also found a statistically significant increase in the I T31 during left circumflex artery occlusions. To evaluate the evolution of VRD indices during acute ischemia, we calculated the relative change parameter R I for each index I. Maximal relative changes (R I ) during acute ischemia were found for the S-VRD indices I T21, the first eigenvalue I λ1 and the second eigenvalue I λ2, with changes 64, 57 and 52 times their baseline range of variation during the control recording, respectively. Also, we found that relative changes with respect to the baseline were higher in patients with T-wave alternans (TWA) than in those without TWA. In conclusion, results suggest that I TPE as well as I T21, I T31 and I TWR are very responsive to dispersion changes induced by ischemia, but with a behavior which very much depends on the occluded artery.

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Abbreviations

2D:

Two dimensional

3D:

Three dimensional

AMI:

Acute myocardial infarction

APD:

Action potential duration

CAD:

Coronary artery disease

CGM:

Cardiogoniometry

ECG:

Electrocardiogram

LAD:

Left anterior descending artery

LCx:

Left circumflex artery

LM:

Left main artery

MAP:

Monophasic action potential

MI:

Myocardial infarction

PCA:

Principal component analysis

PCI:

Percutaneous coronary intervention

RCA:

Right coronary artery

SCD:

Sudden cardiac death

SEM:

Standard error mean

SPECT:

Single-photon emission computed tomography

STAFF-III:

Database of the ECG signals

STEMI:

ST-segment elevation myocardial infarction

SVD:

Singular value decomposition

S-VRD:

Spatial indices of ventricular repolarization dispersion

TP:

Total population

T-VRD:

Temporal indices of ventricular repolarization dispersion

TWA:

T-wave alternans

VCG:

Vectorcardiogram

VRD:

Ventricular repolarization dispersion

σ I :

Standard deviation of I index at control recording

I :

Index

I λ1 :

First eigenvalue

I λ2 :

Second eigenvalue

I λ3 :

Third eigenvalue

I T21 :

Ratio of the second to the first eigenvalues

I T31 :

Ratio of the third to the first eigenvalues

I MTW :

Multilead T-wave width

I TE :

Total energy of the T-wave

I TPE :

T-wave peak-to-end in the lead with maximal level of ST-segment

I TW :

T-wave width in the lead with maximal level of ST-segment

I TWR :

T-wave residuum

R I :

Relative variation of the index I

\(\hbox{ST}_{\rm J+60}\) :

ST level measured at J-point plus 60 ms

T END :

T-wave end

T ON :

T-wave onset

T PEAK :

T-wave peak

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Acknowledgments

This work was supported by the Ministerio de Ciencia e Innovación, Spain, under Projects TEC2010-21703-C03-02, by the Diputación General de Aragón, Spain, through Grupos Consolidados GTC and Fondo Social Europeo ref: T30, by Instituto de Salud Carlos III, Spain, through CIBER CB06/01/0062. This work was also funded by the Consejo Nacional de Investigaciones Científicas y Técnicas (PIP-538) and Agencia Nacional de Promoción Científica y Tecnológica (PICT 2008 nro. 2108), Argentina.

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Authors and Affiliations

  1. Argentine Institute of Mathematics, ‘Alberto P. Calderón’ (CONICET), Saavedra 15, C1083ACA, Buenos Aires, Argentina

    Pedro David Arini

  2. Biomedical Engineering Institute, School of Engineering, University of Buenos Aires (UBA), Paseo Colón 850, C1063ACV, Buenos Aires, Argentina

    Pedro David Arini

  3. Electronic Engineering Department, School of Engineering, University of Buenos Aires (UBA), Paseo Colón 850, C1063ACV, Buenos Aires, Argentina

    Fabricio Hugo Baglivo

  4. Communications Technology Group (GTC), Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, María de Luna 1, Edificio Ada Byron, 50018, Zaragoza, Spain

    Juan Pablo Martínez & Pablo Laguna

  5. Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain

    Juan Pablo Martínez & Pablo Laguna

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  1. Pedro David Arini
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Correspondence to Pedro David Arini.

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Arini, P.D., Baglivo, F.H., Martínez, J.P. et al. Evaluation of ventricular repolarization dispersion during acute myocardial ischemia: spatial and temporal ECG indices. Med Biol Eng Comput 52, 375–391 (2014). https://doi.org/10.1007/s11517-014-1136-z

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