Application of two novel electrical restitution‐based ECG markers of ventricular arrhythmia to patients with nonischemic cardiomyopathy

Nicolson, Will; Smith, M.I.; Vali, Zakariyya; Samani, Nilesh J.; Ng, Guseva

doi:10.1111/pace.14143

Cited by 4 publications

(8 citation statements)

References 25 publications

(37 reference statements)

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“…There are no studies assessing whether the invasively acquired slope of the APDR is related to the risk for hard clinical outcomes such as the onset of ventricular arrhythmias and cardiac death. Previous studies assessing ECG-derived APDR surrogates report increased risk for ventricular arrhythmias or death in patients with ICMP (Nicolson et al, 2014) and non-ICMP (Nicolson et al, 2021) who have steep restitution slopes. However, the hazard ratios reported are 4-4.1 and the ROC 0.61, suggesting that restitution slope alone has at best, modest predictive value.…”

Section: Significance For Clinical Risk Stratification Using Virtual Heart Modelingmentioning

confidence: 95%

Characterization of the Electrophysiologic Remodeling of Patients With Ischemic Cardiomyopathy by Clinical Measurements and Computer Simulations Coupled With Machine Learning

et al. 2021

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RationalePatients with ischemic cardiomyopathy (ICMP) are at high risk for malignant arrhythmias, largely due to electrophysiological remodeling of the non-infarcted myocardium. The electrophysiological properties of the non-infarcted myocardium of patients with ICMP remain largely unknown.ObjectivesTo assess the pro-arrhythmic behavior of non-infarcted myocardium in ICMP patients and couple computational simulations with machine learning to establish a methodology for the development of disease-specific action potential models based on clinically measured action potential duration restitution (APDR) data.Methods and ResultsWe enrolled 22 patients undergoing left-sided ablation (10 ICMP) and compared APDRs between ICMP and structurally normal left ventricles (SNLVs). APDRs were clinically assessed with a decremental pacing protocol. Using genetic algorithms (GAs), we constructed populations of action potential models that incorporate the cohort-specific APDRs. The variability in the populations of ICMP and SNLV models was captured by clustering models based on their similarity using unsupervised machine learning. The pro-arrhythmic potential of ICMP and SNLV models was assessed in cell- and tissue-level simulations. Clinical measurements established that ICMP patients have a steeper APDR slope compared to SNLV (by 38%, p < 0.01). In cell-level simulations, APD alternans were induced in ICMP models at a longer cycle length compared to SNLV models (385–400 vs 355 ms). In tissue-level simulations, ICMP models were more susceptible for sustained functional re-entry compared to SNLV models.ConclusionMyocardial remodeling in ICMP patients is manifested as a steeper APDR compared to SNLV, which underlies the greater arrhythmogenic propensity in these patients, as demonstrated by cell- and tissue-level simulations using action potential models developed by GAs from clinical measurements. The methodology presented here captures the uncertainty inherent to GAs model development and provides a blueprint for use in future studies aimed at evaluating electrophysiological remodeling resulting from other cardiac diseases.

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Section: Significance For Clinical Risk Stratification Using Virtual Heart Modelingmentioning

confidence: 95%

Characterization of the Electrophysiologic Remodeling of Patients With Ischemic Cardiomyopathy by Clinical Measurements and Computer Simulations Coupled With Machine Learning

et al. 2021

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“…The analysis of the ECG signals data was based on the feature extraction and wave delineation system developed by Madeiro and colleagues 12,13 . The method was validated for reproducibility in two studies 6,7 and has been used in other studies 8 …”

Section: Methodsmentioning

confidence: 99%

“…The analysis of the ECG signals data was based on the feature extraction and wave delineation system developed by Madeiro and colleagues. 12,13 The method was validated for reproducibility in two studies 6,7 and has been used in other studies. 8 The feature extraction steps were applied to ECG data between the 4 AM to 8 AM period (greater sympathetic effect) 14 for each patient.…”

Section: -H Ecg Segments Digital Single-leadmentioning

confidence: 99%

“…Therefore, it is plausible to conjecture that the CC seems a perfect candidate for the evaluation of ventricular repolarization parameters. The action potential duration restitution (APDR) dynamics (see Supplementary material) is presumed to represent a non‐invasive measure of the regional heterogeneity of ventricular repolarization and a potential marker arrhythmogenic risk 6,7 . As a proof‐of‐concept, it has been studied in ischaemic 6 and non‐ischaemic 7 cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

“…The action potential duration restitution (APDR) dynamics (see Supplementary material) is presumed to represent a non‐invasive measure of the regional heterogeneity of ventricular repolarization and a potential marker arrhythmogenic risk 6,7 . As a proof‐of‐concept, it has been studied in ischaemic 6 and non‐ischaemic 7 cardiomyopathy. We believe that a better understanding of the electrophysiological heterogeneity involved in SCD could better identify events treatable with ICD and, therefore, influence clinical decisions in this regard in CC.…”

Section: Introductionmentioning

confidence: 99%

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Risk stratifier for sudden cardiac death beyond the left ventricular ejection fraction in Chagas cardiomyopathy

Pedrosa,

Paulo do Vale Madeiro,

Alberto

et al. 2023

Pacing Clinical Electrophis

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BackgroundSudden cardiac death (SCD) risk markers are needed in Chagas cardiomyopathy (CC). Action potential duration restitution (APDR) dynamics is capable of extracting information on cardiac regional heterogeneity. This study intends to develop a patient‐specific variables‐based algorithm to predict SCD in the low‐intermediate subgroups of the Rassi risk score.MethodsCross‐sectional study of patients who underwent 24‐h Holter for research purposes between January 1992 and February 2017. From 4‐h ECG segment, RR series were generated and APDR dynamics metrics were calculated. Classification tree and sensitivity analysis were applied. As outcomes, SCD, SCD‐free and non‐cardiovascular death and 34 variables were included.ResultsTwo hundred twenty‐one (129 in the group SCD‐free, 80 in the SCD group and 12 non‐cardiovascular death group) were analyzed. In the groups with and without SCD (209 patients), the median age was 66 years, 52% were female, the cardiac involvement was mild to moderate in 72% with a Rassi point median of 8 (IQ: 3 to 11). The SCD group had more ventricular remodeling and more ventricular electrical instability. The occurrence of a %beats QTend/TendQ ratio > 1 (AUC, 0.96 (95% CI 0.89–0.98) present in more than 56.7% of the 4‐h ECG segments was sufficient to identify patients of the SCD subgroup. Variables representing different stages of CC were also relevant in the model.ConclusionIt is possible to use APDR dynamics as an adjuvant in the SCD risk assessment in a subgroup of patients with a high risk of SCD and a very low risk of non‐CV death with high power of discrimination.

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Non-invasive markers for sudden cardiac death risk stratification in dilated cardiomyopathy

Pooranachandran

Nicolson

Vali

et al. 2021

Heart

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Dilated cardiomyopathy (DCM) is a common yet challenging cardiac disease. Great strides have been made in improving DCM prognosis due to heart failure but sudden cardiac death (SCD) due to ventricular arrhythmias remains significant and challenging to predict. High-risk patients can be effectively managed with implantable cardioverter defibrillators (ICDs) but because identification of what is high risk is very limited, many patients unnecessarily experience the morbidity associated with an ICD implant and many others are not identified and have preventable mortality. Current guidelines recommend use of left ventricular ejection fraction and New York Heart Association class as the main markers of risk stratification to identify patients who would be at higher risk of SCD. However, when analysing the data from the trials that these recommendations are based on, the number of patients in whom an ICD delivers appropriate therapy is modest. In order to improve the effectiveness of therapy with an ICD, the patients who are most likely to benefit need to be identified. This review article presents the evidence behind current guideline-directed SCD risk markers and then explores new potential imaging, electrophysiological and genetic risk markers for SCD in DCM.

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Application of two novel electrical restitution‐based ECG markers of ventricular arrhythmia to patients with nonischemic cardiomyopathy

Cited by 4 publications

References 25 publications

Characterization of the Electrophysiologic Remodeling of Patients With Ischemic Cardiomyopathy by Clinical Measurements and Computer Simulations Coupled With Machine Learning

Characterization of the Electrophysiologic Remodeling of Patients With Ischemic Cardiomyopathy by Clinical Measurements and Computer Simulations Coupled With Machine Learning

Risk stratifier for sudden cardiac death beyond the left ventricular ejection fraction in Chagas cardiomyopathy

Non-invasive markers for sudden cardiac death risk stratification in dilated cardiomyopathy

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