Ambulatory measurement of the <scp>ECG T</scp>‐wave amplitude

Lien, René van; Neijts, Melanie; Willemsen, Gonneke; Geus, Eco J. C. de

doi:10.1111/psyp.12300

Cited by 37 publications

(25 citation statements)

References 105 publications

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“…atropine) and activation of the SNS with head-up tilt cause a significant decrease of TWA, while blocking the SNS with beta-adrenoceptor antagonists provokes its significant increase [8]–[11]. In order to calculateTWA, these studies rely on manual annotations [8], [9], or on software performing ECG waveform averaging that still require human interaction [10], [11]. Thus, the absence of completely automatic methods to evaluate the TWA make the research in this field time-consuming and not directly applicable in the clinical world.…”

Section: Introductionmentioning

confidence: 99%

A New Wavelet-Based ECG Delineator for the Evaluation of the Ventricular Innervation

Cesari

Mehlsen

et al. 2017

IEEE J. Transl. Eng. Health Med.

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T-wave amplitude (TWA) has been proposed as a marker of the innervation of the myocardium. Until now, TWA has been calculated manually or with poor algorithms, thus making its use not efficient in a clinical environment. We introduce a new wavelet-based algorithm for the delineation QRS complexes and T-waves, and the automatic calculation of TWA. When validated in the MIT/BIH Arrhythmia database, the QRS detector achieved sensitivity and positive predictive value of 99.84% and 99.87%, respectively. The algorithm was validated also on the QT database and it achieved sensitivity of 99.50% for T-peak detection. In addition, the algorithm achieved delineation accuracy that is similar to the differences in delineation between expert cardiologists. We applied the algorithm for the evaluation of the influence in TWA of anticholinergic and antiadrenergic drugs (i.e., atropine and metoprolol) for healthy subjects. We found that the TWA decreased significantly with atropine and that metoprolol caused a significant increase in TWA, thus confirming the clinical hypothesis that the TWA is a marker of the innervation of the myocardium. The results of this paper show that the proposed algorithm can be used as a useful and efficient tool in clinical practice for the automatic calculation of TWA and its interpretation as a non-invasive marker of the autonomic ventricular innervation.

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Section: Introductionmentioning

confidence: 99%

A New Wavelet-Based ECG Delineator for the Evaluation of the Ventricular Innervation

Cesari

Mehlsen

et al. 2017

IEEE J. Transl. Eng. Health Med.

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“…33 Abnormalities in repolarization may also be owing to a history of silent myocardial infarctions 34 or undiagnosed heart failure and/or cardiomyopathy. 35,36 Another possibility is that repolarization abnormalities indicated by QT prolongation and abnormal T axis reflect an increased risk for sudden cardiac death independent of cardiac structure or autonomic function, perhaps via genetic or other pathways.…”

Section: Discussionmentioning

confidence: 99%

An Electrocardiogram-Based Risk Equation for Incident Cardiovascular Disease From the National Health and Nutrition Examination Survey

et al. 2016

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IMPORTANCE Electrocardiography (ECG) may detect subclinical cardiovascular disease (CVD) in asymptomatic individuals, but its role in assessing adverse events beyond traditional risk factors is not clear. Interval and vector data that are commonly available on modern ECGs may offer independent prognostic information that improves risk classification. OBJECTIVES To derive and validate a CVD risk equation based on ECG metrics and to determine its incremental benefit in addition to the Framingham risk score (FRS). DESIGN, SETTING, AND PARTICIPANTS This study included 3640 randomly selected community-based adults aged 40 to 74 years without known CVD from the First National Health and Nutrition Examination Survey (NHANES I) cohort (1971–1975) and 6329 from the NHANES III cohort (1988–1994). Participants were sampled from across the United States. A risk score to assess incident nonfatal and fatal CVD events was derived based on computer-generated ECG data, including frontal P, R, and T axes; heart rate; and PR, QRS, and QT intervals from NHANES I. The most prognostic variables, along with age and sex, were incorporated into the NHANES ECG risk equation. The equation was evaluated in the NHANES III cohort for an independent validation. Follow-up in the NHANES III cohort was completed on December 31, 2006. Data for this study were analyzed from August 11, 2015, to May 20, 2016. MAIN OUTCOMES AND MEASURES The primary end point was CVD death. Secondary outcomes included 10-year ischemic heart disease and all-cause death. RESULTS The final study sample included 9969 participants (4714 men [47.3%]; 5255 women [52.7%]; mean [SD] age, 55.3 [10.1] years) from both cohorts. Frontal T axis, heart rate, and heart rate–corrected QT interval were the most significant ECG factors in the NHANES I cohort. In the validation cohort (NHANES III), the equation provided for prognostic information for fatal CVD with a hazard ratio (HR) of 3.23 (95% CI, 2.82–3.72); the C statistic was 0.79 (95% CI, 0.76–0.81). When added to the FRS in Cox proportional hazards regression models, the categorical (1%, 5%, and 10% cutoffs) net reclassification improvement was 24%. When the FRS and ECG scores were combined in a single model, the C statistic improved by 0.04 (95% CI, 0.02–0.06) to 0.80 (95% CI, 0.77–0.82). Similar improvements were noted when the ECG score was added to the pooled cohort equation. When the equation for prognostic information about ischemic heart disease and all-cause death was evaluated, the results were similar. CONCLUSIONS AND RELEVANCE An ECG risk score based on age, sex, heart rate, frontal T axis, and QT interval assesses the risk for CVD and compares favorably with the FRS alone in an independent cohort of asymptomatic individuals. Although the ECG risk equation is low cost, further research is needed to ascertain whether this additional step in risk stratification may improve prevention efforts and reduce CVD events.

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“…The biphasic T wave produced by the electrode configuration in this study precluded measurement of the end of the T wave using the intersection of a tangent to the downslope of the T wave with the isoelectric line. Instead, T offset was used as the end of the T wave in this study as previously published (Van Lien et al, 2015 ) and described here (see Materials and Methods). The major limitation of our approach is that in binning beats based on RR interval we are unable to take into account effects related to changes in autonomic tone, circadian variability in QT interval or QT hysteresis.…”

Section: Discussionmentioning

confidence: 99%

“…(i) Q: first deflection from the isoelectric line after the P-wave, (ii) R: peak of the QRS complex, (iii) S: intersection of S wave upstroke and T-P isoelectric line, (iv) T peak : peak of the T-wave, (v) T offset : the point 95% of the distance from T-peak to the minimum of the T wave. Since the modified CS5 lead positioning can result in biphasic T-waves (where the end of the T wave overshoots the isoelectric line; Figure 1 ), the minimum point is typically taken as the end of the T wave (Van Lien et al, 2015 ). However, since this minimum was sometimes very shallow, the time of the absolute minimum was difficult to precisely identify.…”

Section: Methodsmentioning

confidence: 99%

Heritability of ECG Biomarkers in the Netherlands Twin Registry Measured from Holter ECGs

et al. 2016

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Introduction: The resting ECG is the most commonly used tool to assess cardiac electrophysiology. Previous studies have estimated heritability of ECG parameters based on these snapshots of the cardiac electrical activity. In this study we set out to determine whether analysis of heart rate specific data from Holter ECGs allows more complete assessment of the heritability of ECG parameters.Methods and Results: Holter ECGs were recorded from 221 twin pairs and analyzed using a multi-parameter beat binning approach. Heart rate dependent estimates of heritability for QRS duration, QT interval, Tpeak–Tend and Theight were calculated using structural equation modeling. QRS duration is largely determined by environmental factors whereas repolarization is primarily genetically determined. Heritability estimates of both QT interval and Theight were significantly higher when measured from Holter compared to resting ECGs and the heritability estimate of each was heart rate dependent. Analysis of the genetic contribution to correlation between repolarization parameters demonstrated that covariance of individual ECG parameters at different heart rates overlap but at each specific heart rate there was relatively little overlap in the genetic determinants of the different repolarization parameters.Conclusions: Here we present the first study of heritability of repolarization parameters measured from Holter ECGs. Our data demonstrate that higher heritability can be estimated from the Holter than the resting ECG and reveals rate dependence in the genetic—environmental determinants of the ECG that has not previously been tractable. Future applications include deeper dissection of the ECG of participants with inherited cardiac electrical disease.

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Ambulatory measurement of the ECG T‐wave amplitude

Cited by 37 publications

References 105 publications

A New Wavelet-Based ECG Delineator for the Evaluation of the Ventricular Innervation

A New Wavelet-Based ECG Delineator for the Evaluation of the Ventricular Innervation

An Electrocardiogram-Based Risk Equation for Incident Cardiovascular Disease From the National Health and Nutrition Examination Survey

Heritability of ECG Biomarkers in the Netherlands Twin Registry Measured from Holter ECGs

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