Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure

Monasterio, Violeta; Laguna, Pablo; Cygankiewicz, Iwona; Vázquez, Rafael; Bayés‐Genís, Antoni; Luna, Antoni Bayés de; Martínez, Juan Pablo

doi:10.1016/j.hrthm.2011.10.027

Cited by 40 publications

(62 citation statements)

References 27 publications

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“…From these values clinical indices need to be derived, particularly when long term recordings are processed [107]. Some indices reflect the average amplitude of TWA and others quantify the maximum TWA amplitude in specific segments under study.…”

Section: Periodic Component Analysismentioning

confidence: 99%

“…Some indices reflect the average amplitude of TWA and others quantify the maximum TWA amplitude in specific segments under study. An index of the former type is described as index of average alternans (IAA) and their corresponding versions after restriction to a specific interval for a HR value X are described as HRrestricted indices of average alternans (IAA X ), all of them proposed in [107]. IAA was computed as the average of all V alt measured in 128-beat data windows during the 24-hour period, thus reflecting the average TWA activity.…”

Section: Periodic Component Analysismentioning

confidence: 99%

“…Therefore IAA 90 reflects the average TWA activity at HR between 80 and 90 beats/min in 24 hours. Clinical studies where these multi-lead techniques have already being applied can be found in [107] and [108].…”

Section: Periodic Component Analysismentioning

confidence: 99%

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Techniques for Ventricular Repolarization Instability Assessment From the ECG

2016

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Abstract-Instabilities in ventricular repolarization have been documented to be tightly linked to arrhythmia vulnerability. Translation of the information contained in the repolarization phase of the ECG into valuable clinical decision-making tools remains challenging. This work aims at providing an overview of the last advances in the proposal and quantification of ECG-derived indices that describe repolarization properties and whose alterations are related with threatening arrhythmogenic conditions. A review of the state-of-the-art is provided, spanning from the electrophysiological basis of ventricular repolarization to its characterization on the surface ECG through a set of temporal and spatial risk markers.Index Terms-Electrophysiological basis of the ECG, ECG waves, ECG intervals, repolarization instabilities, spatial and temporal ventricular repolarization dispersion, cardiac arrhythmias, biophysical modeling of the ECG, ECG signal processing, repolarization risk markers, T wave alternans, QT variability.

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Section: Periodic Component Analysismentioning

confidence: 99%

Section: Periodic Component Analysismentioning

confidence: 99%

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Techniques for Ventricular Repolarization Instability Assessment From the ECG

2016

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“…Index of average alternans (IAA), quantifying the average TWA level, was measured in consecutive 6-hour intervals (00.00-06.00 h; 06.00-12.00 h; 12.00-18.00 h; 18.00-24.00 h) using a multilead fully automated method based on periodic component analysis (πCA) combined with the Laplacian likelihood ratio method (LLRM) [2].…”

Section: Twa Measurementmentioning

confidence: 99%

“…It is presently regarded as a noninvasive risk marker for identifying patients at risk for SCD and ventricular vulnerability [1]. Although the long-term averaging of TWA activity in ambulatory recordings has been shown to be an independent predictor of SCD in CHF [2], the influence of circadian rhythms on TWA remains still understudied.…”

Section: Introductionmentioning

confidence: 99%

Circadian modulation on T-wave alternans activity in chronic heart failure patients

Martín-Yebra

Caiani

Laguna

et al. 2015

2015 Computing in Cardiology Conference (CinC)

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Pulse Arrival Time and Pulse Interval as Accurate Markers to Detect Mechanical Alternans

et al. 2019

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Mechanical alternans (MA) is a powerful predictor of adverse prognosis in patients with heart failure and cardiomyopathy, but its use remains limited due to the need of invasive continuous arterial pressure recordings. This study aims to assess novel cardiovascular correlates of MA in the intact human heart to facilitate affordable and non-invasive detection of MA and advance our understanding of the underlying pathophysiology. Arterial pressure, respiration, and ECG were recorded in 12 subjects with healthy ventricles during voluntarily controlled breathing at different respiratory rate, before and after administration of beta-blockers. MA was induced by ventricular pacing. A total of 67 recordings lasting approximately 90 s each were analyzed. Mechanical alternans (MA) was measured in the systolic blood pressure. We studied cardiovascular correlates of MA, including maximum pressure rise during systole (dPdt max ), pulse arrival time (PAT), pulse wave interval (PI), RR interval (RRI), ECG QRS complexes and T-waves. MA was detected in 30% of the analyzed recordings. Beta-blockade significantly reduced MA prevalence (from 50 to 11%, p < 0.05). Binary classification showed that MA was detected by alternans in dPdt max (100% sens, 96% spec), PAT (100% sens, 81% spec) and PI (80% sens, 81% spec). Alternans in PAT and in PI also showed high degree of temporal synchronization with MA (80 ± 33 and 73 ± 40%, respectively). These data suggest that cardiac contractility is a primary factor in the establishment of MA. Our findings show that MA was highly correlated with invasive measurements of PAT and PI. Since PAT and PI can be estimated using non-invasive technologies, these markers could potentially enable affordable MA detection for risk-prediction. Electronic supplementary material The online version of this article (10.1007/s10439-019-02221-4) contains supplementary material, which is available to authorized users.

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Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure

Cited by 40 publications

References 27 publications

Techniques for Ventricular Repolarization Instability Assessment From the ECG

Techniques for Ventricular Repolarization Instability Assessment From the ECG

Circadian modulation on T-wave alternans activity in chronic heart failure patients

Pulse Arrival Time and Pulse Interval as Accurate Markers to Detect Mechanical Alternans

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