Time‐ and frequency‐domain analysis of repolarization phase during recovery from exercise in healthy subjects

Piccirillo, Gianfranco; Moscucci, Federica; Iorio, Carlo; Fabietti, Marcella; Mastropietri, Fabiola; Crapanzano, Davide; Bertani, Gaetano; Sabatino, Teresa; Zaccagnini, Giulia; Lospinuso, Ilaria; Magrì, Damiano

doi:10.1111/pace.14038

Cited by 4 publications

(10 citation statements)

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“…We believe sympathetic hyperactivity and neurohumoral activation could influence the Te and TeSD. In previous studies, it was reported that sympathetic activation during exercise was able to induce an increase in Te and TeSD in normal subjects [50]. In animal models, we observed an increase in the short-term variability of the Te interval during pacinginduced acute congestive heart failure and experimental acute myocardial ischemia [35,51].…”

Section: Discussionsupporting

confidence: 59%

Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients

Piccirillo,

Moscucci,

Mezzadri

et al. 2024

Biomedicines

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Objectives: The first aim of this study was to assess the predictive power of Tend interval (Te) and non-invasive hemodynamic markers, based on bioimpedance in decompensated chronic heart failure (CHF). The second one was to verify the possible differences in repolarization and hemodynamic data between CHF patients grouped by level of left ventricular ejection fraction (LVEF). Finally, we wanted to check if repolarization and hemodynamic data changed with clinical improvement or worsening in CHF patients. Methods: Two hundred and forty-three decompensated CHF patients were studied by 5 min ECG recordings to determine the mean and standard deviation (TeSD) of Te (first study). In a subgroup of 129 patients (second study), non-invasive hemodynamic and repolarization data were recorded for further evaluation. Results: Total in-hospital and cardiovascular mortality rates were respectively 19 and 9%. Te was higher in the deceased than in surviving subjects (Te: 120 ± 28 vs. 100 ± 25 ms) and multivariable logistic regression analysis reported that Te was related to an increase of total (χ2: 35.45, odds ratio: 1.03, 95% confidence limit: 1.02–1.05, p < 0.001) and cardiovascular mortality (χ2: 32.58, odds ratio: 1.04, 95% confidence limit: 1.02–1.06, p < 0.001). Subjects with heart failure with reduced ejection fraction (HFrEF) reported higher levels of repolarization and lower non-invasive systolic hemodynamic data in comparison to those with preserved ejection fraction (HFpEF). In the subgroup, patients with the NT-proBNP reduction after therapy showed a lower rate of Te, heart rate, blood pressures, contractility index, and left ventricular ejection time in comparison with the patients without NT-proBNP reduction. Conclusion: Electrical signals from ECG and bioimpedance were capable of monitoring the patients with advanced decompensated CHF. These simple, inexpensive, non-invasive, easily repeatable, and transmissible markers could represent a tool to remotely monitor and to intercept the possible worsening of these patients early by machine learning and artificial intelligence tools.

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Section: Discussionsupporting

confidence: 59%

Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients

Piccirillo,

Moscucci,

Mezzadri

et al. 2024

Biomedicines

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“…result is a prolonged temporal dispersion of QT and Te. [14][15][16][17] Recent observations have highlighted that sympathetic hyperactivity is able to induce an increase in QTe variability index, QTeVN, TeVN, TeSD, in normal 17 and pathological 23,24 conditions. Thus, the morphological and structural alterations of the myocardium resulting in specific modifications of these electrocardiographic markers.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, sodium, calcium, and potassium channels and transport mechanisms are upset in CHF 22 and the final result is a prolonged temporal dispersion of QT and Te. 14 , 15 , 16 , 17 Recent observations have highlighted that sympathetic hyperactivity is able to induce an increase in QTe variability index, QTeVN, TeVN, TeSD, in normal 17 and pathological 23 , 24 conditions.…”

Section: Discussionmentioning

confidence: 99%

“…We, therefore, calculated mean, variance, and SD (QTSD and TeSD) values for each of these repolarization phase intervals and, finally, we calculated the VN for a mean of QT (QTVN) and Te (TeVN) 12 , 14 , 15 , 16 , 17 :…”

Section: Methodsmentioning

confidence: 99%

“…To identify the repolarization intervals, we used software originally proposed by Berger 10 and validated in other studies. [11][12][13][14] We, therefore, calculated mean, variance, and SD (QTSD and TeSD) values for each of these repolarization phase intervals and, finally, we calculated the VN for a mean of QT (QTVN) and Te (TeVN) 12,[14][15][16][17] : QTVN = QT variance/(QTe mean) 2 , TeVN = Te variance/(Te mean) 2 .…”

Section: Offline Data Analysismentioning

confidence: 99%

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QT and Tpeak‐Tend interval variability: Predictive electrical markers of hospital stay length and mortality in acute decompensated heart failure. Preliminary data

Piccirillo

Moscucci

Carnovale

et al. 2022

Clinical Cardiology

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Background As previously reported, an increased repolarization temporal imbalance induces a higher risk of total/cardiovascular mortality. Hypothesis The aim of this study was to assess if the electrocardiographic short period markers of repolarization temporal dispersion could be predictive of the hospital stay length and mortality in patients with acutely decompensated chronic heart failure (CHF). Method Mean, standard deviation (SD), and normalized variance (VN) of QT (QT) and Tpeak‐Tend (Te) were obtained on 5‐min ECG recording in 139 patients hospitalized for acutely decompensated CHF, subgrouping the patients for hospital length of stay (LoS): less or equal 1 week (≤1 W) and those with more than 1 week (>1 W). Results We observed an increase of short‐period repolarization variables (TeSD and TeVN, p < .05), a decrease of blood pressure (p < .05), lower ejection fraction (p < .05), and higher plasma level of biomarkers (NT‐proBNP, p < .001; Troponin, p < .05) in >1 W LoS subjects. 30‐day deceased subjects reported significantly higher levels of QTSD (p < .05), Te mean (p < .001), TeSD (p < .05), QTVN (p < .05) in comparison to the survivors. Multivariable Cox regression analysis reported that TeVN was a risk factor for longer hospital stay (hazard ratio: 1.04, 95% confidence limit: 1.01–1.08, p < .05); whereas, a longer Te mean was associated with higher mortality risk (hazard ratio: 1.02, 95% confidence limit: 1.01–1.03, p < .05). Conclusion A longer hospital stay is considered a clinical surrogate of CHF severity, we confirmed this finding. Therefore, these electrical and simple parameters could be used as noninvasive, transmissible, inexpensive markers of CHF severity and mortality.

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Chronic Heart Failure Management: Monitoring Patients and Intercepting Exacerbations

Piccirillo¹,

Moscucci²,

Sciomer³

et al. 2023

Rev. Cardiovasc. Med.

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Despite significant progress in the field of therapy and management, chronic heart failure (CHF) still remains one of the most common causes of morbidity and mortality, especially among the elderly in Western countries. In particular, frequent episodes of decompensation and, consequently, repeated hospitalizations represent an unsustainable burden for national health systems and the cause of worsening quality of life. CHF is more prevalent in elderly women, who often have “peculiar” clinical characteristics and a more preserved ejection fraction caused by endothelial dysfunction and micro-vessel damage. At the moment, noninvasive technologies that are able to remotely monitor these patients are not widely available yet, and clinical trials are underway to evaluate invasive remote sensors. Unfortunately, implantable devices for identifying decompensation are not the most practical solution in the majority of of patients with chronic heart failure. In particular, they are hypothesized to have the possibility of monitoring patients by pro-B-type natriuretic peptide, ventricular repolarization variability, and bioimpedance cardiography at the first point of care, but new technology and clinical trials must be planned to address the development and spread of these emergent possibilities.

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Time‐ and frequency‐domain analysis of repolarization phase during recovery from exercise in healthy subjects

Cited by 4 publications

References 31 publications

Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients

Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients

QT and Tpeak‐Tend interval variability: Predictive electrical markers of hospital stay length and mortality in acute decompensated heart failure. Preliminary data

Chronic Heart Failure Management: Monitoring Patients and Intercepting Exacerbations

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