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Spatial indices of repolarization correlate with non-ST elevation myocardial ischemia in patients with chest pain

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Abstract

Mild-to-moderate ischemia does not result in ST segment elevation on the electrocardiogram (ECG), but rather non-specific changes in the T wave, which are frequently labeled as non-diagnostic for ischemia. Robust methods to quantify such T wave heterogeneity can have immediate clinical applications. We sought to evaluate the effects of spontaneous ischemia on the evolution of spatial T wave changes, based on the eigenvalues of the spatial correlation matrix of the ECG, in patients undergoing nuclear cardiac imaging for evaluating intermittent chest pain. We computed T wave complexity (TWC), the ratio of the second to the first eigenvalue of repolarization, from 5-min baseline and 5-min peak-stress Holter ECG recordings. Our sample included 30 males and 20 females aged 63 ± 11 years. Compared to baseline, significant changes in TWC were only seen in patients with ischemia (n = 10) during stress testing, but not among others. The absolute changes in TWC were significantly larger in the ischemia group compared to others, with a pattern that seemed to depend on the severity or anatomic distribution of ischemia. Our results demonstrate that ischemia-induced changes in T wave morphology can be meaningfully quantified from the surface 12-lead ECG, suggesting an important opportunity for improving diagnostics in patients with chest pain.

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Abbreviations

AMI:

Acute myocardial infarction

AP:

Action potential

CAD:

Coronary artery disease

ECG:

Electrocardiogram

LAD:

Left anterior descending coronary artery

LCX:

Left circumflex coronary artery

PCA:

Principal component analysis

PCI:

Percutaneous coronary intervention

RCA:

Right coronary artery

ROC:

Receiver operator characteristics curve

R TWC :

Changes in T wave complexity relative to baseline variations

SPECT:

Single-photon emission computed tomography

SDNN:

Standard deviation of normal-to-normal R-R interval

TWC:

T wave complexity

VRD:

Ventricular repolarization dispersion

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Authors and Affiliations

  1. Department of Acute & Tertiary Care Nursing, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria St, Pittsburgh, PA, 15261, USA

    Salah Al-Zaiti

  2. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Salah Al-Zaiti & Clifton Callaway

  3. Department of Computer & Electrical Engineering, University of Pittsburgh, Pittsburgh, PA, USA

    Ervin Sejdić

  4. Department of Cardiac Electrophysiology, University of Pittsburgh, Pittsburgh, PA, USA

    Jan Nemec

  5. Department of Nuclear Cardiology, University of Pittsburgh, Pittsburgh,, PA, USA

    Prem Soman

  6. Department of Cardiovascular Medicine, University of Utah, Salt Lake, UT, USA

    Robert Lux

Authors
  1. Salah Al-Zaiti
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  2. Ervin Sejdić
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  3. Jan Nemec
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  4. Clifton Callaway
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  5. Prem Soman
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  6. Robert Lux
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Corresponding author

Correspondence to Salah Al-Zaiti.

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Funding

Funding was provided by the Central Research development Grant from University of Pittsburgh (PI Al-Zaiti).

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Dr. Jan Nemec passed away on May 7, 2017

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Cite this article

Al-Zaiti, S., Sejdić, E., Nemec, J. et al. Spatial indices of repolarization correlate with non-ST elevation myocardial ischemia in patients with chest pain. Med Biol Eng Comput 56, 1–12 (2018). https://doi.org/10.1007/s11517-017-1659-1

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  • DOI: https://doi.org/10.1007/s11517-017-1659-1

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