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Microvolt t-wave alternans complemented with electrophysiologic study for prediction of ventricular tachyarrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: a long-term follow-up study

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Chinese Medical Journal 2019年第12期132卷 1406-1413页

作者： She-Liang Xue Xiao-Feng Hou Kang-Yun Sun Yao Wang Zhi-Yong Qian Quan-Peng Wang Si-Peng Shen Hong-Li Yin Rong Zhang Hai-Ping Yin Jian-Gang Zou Department of Cardiology The First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China Department of Cardiology The Affiliated Wujin Hospital of Jiangsu UniversityChangzhouJiangsu 213002China Department of Cardiology The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhouJiangsu 215008China Department of Biostatistics School of Public HealthNanjing Medical UniversityNanjingJiangsu 211166China Key Laboratory of targeted Intervention in Cardiovascular Disease Collaborative Inn ovation Center for Cardiovascular Disease Translational MedicineNanjing Medical University NanjingJiangsu 211166China

Background: the long-term predicted value of microvolt t-wave alternans (MtWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MtWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MtWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (Vt), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. the maximal tWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained Vt was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible Vt was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. the receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. the multivariate Cox regression model for survival showed that MtWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible Vt (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MtWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.

关键词： Modified moving average analysis Microvolt t-wave alternans Electrophysiologic study Ventricular tachyarrhythmia Arrhythmogenic right ventricular cardiomyopathy

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Cardiac and non-cardiac causes of t-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature

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World Journal of Cardiology 2015年第2期7卷 86-100页

作者： Salah AM Said Rene Bloo Ramon de Nooijer Andries Slootweg Department of Cardiology Hospital Group TwenteAlmelo-Hengelo7555 DL Hengelo The Netherlands

AIM: to describe the electrocardiographic(ECG) phenomena characterized by t-wave inversion in the precordial leads in adults and to highlight its differential diagnosis. MEtHODS: A retrospective chart review of 8 adult patients who were admitted with ECG t-wave inversion in the anterior chest leads with or without prolongation of corrected Qt(Qtc) interval. they had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality noninvasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. the diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary ***: Eight adult subjects(5 females) with a mean age of 66 years(range 51 to 82) are analyzed. the etiology of t-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the Qtc interval. the longest Qtc interval(639 ms) was found in the patient with pheochromocytoma. Giant t-wave inversion(≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. the deepest t-wave was measured in lead V3(5 ×). In 3 patients presented with mild t-wave inversion(patients 1, 5 and 4 mm), the Qtc interval was not prolonged(432, 409 and 424 msec), ***: t-wave inversion associated with or without Qtc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.

关键词： t-wave inversion Coronary angiography Pulmonary computed tomography angiography Mag-netic resonance imaging Differential diagnosis

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Adaptive Match-Filtering: A Biomedical Application to Identify t-wave Alternans

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Natural Science 2014年第10期6卷 709-718页

作者： Laura Burattini Giovanni Ottaviano Francesco Di Nardo Sandro Fioretti B.M.E.D. Bio-Medical Engineering Development SRL Università Politecnica delle Marche Ancona Italy Department of Information Engineering Università Politecnica delle Marche Ancona Italy

t-wave alternans (tWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (t-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a frequency component, termed ftWA, that matches half heart rate. the heart-rate adaptive match filter (AMF) based method is a technique for automatic tWA identification from the digital ECG. Aim of the present study was to provide a complete technical description of the filter able to explain its methodological principles. the AMF is usually realized as a 6th order Butterworth filter with a narrow (0.12 Hz) passing band centered in ftWA. It is applied in a bidirectional fashion, so that final filtering order is 12. While extracting the tWA component, the AMF simultaneously filters out every ECG component including noise and artefacts, and thus results are very robust. Goodness of the technique was tested using 8 synthetic ECG tracings corrupted by typical noisy factors, such as white random noise, baseline wanderings, heart-rate variability, and others. Six ECG tracings were affected by 100 μV tWA, whereas two were not. Results indicate that the AMF-based method is able to prevent false-positive and false-negative detections and, thus, represents a useful tool for a reliable tWA identification.

关键词： Adaptive Filtering Digital ECG t-wave Alternans Sudden Cardiac Death

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Application of t-wave Alternans in Evaluation of Prognosis in Patients with Intracerebral Hemorrhage

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Yangtze Medicine 2017年第3期1卷 127-132页

作者： Xian Li Xianglin Cheng Department of Neurology The Clinical Medicine School of Yangtze University The First Affiliated Hospital of Yangtze University Jingzhou China

Objective: to explore the application value of electrocardiograph (ECG) t-wave Alternans (tWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients whose conventional 12-lead ECG has tWA in our hospital from January 2011 to December 2015, 751 patients without tWA in the same period as the control group, compared the volume of intracerebral hemorrhage, bleeding site and mortality between the 2 groups. Results: In tWA group, 247 cases died, 361 cases with massive intracerebral hemorrhage, 298 cases with brain stem hemorrhage;in tWA negative group (control group), 41 cases died, 93 cases with massive brain hemorrhage, 64 cases with brain stem hemorrhage. there are statistical differences between two groups (P Conclusion: the occurrence of tWA is significantly related to the volume of bleeding, the bleeding site and mortality, and can be used as an important parameter in the prognosis of intracerebral hemorrhage.

关键词： Intracerebral Hemorrhage t-wave Alternans Prognosis

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On the basis of the morphology of the t-wave alternans: A Poincare mapping method research

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Journal of Biomedical Science and Engineering 2013年第4期6卷 504-507页

作者： Hui Guo Jie Zhao Fei Li tiantian Li College of Physics and Electronics Shandong Normal University Jinan China

Presently t-wave alternans (tWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting t-wave alternate accurately is particularly important. this paper introduces an algorithm for detecting tWA using Poincare mapping method which is a technique for nonlinear dynamic systems to display periodic behavior. Sample series of beat to beat cycles were selected to prepare Poincare mapping method. Vector Angle Index (VAI), which is the mean of the difference between θi (the angle between the line connecting the i point to the origin and the X axis) and 45 degrees was used to present the presence or absence of tWA. the value of 0.9 rad ≤ VAI ≤ 1.03 rad is accepted as a level determinative for presence of tWA. VAI via Poincare mapping method (PM) is used for correlation analysis with t-wave alternans voltage (Vtwa) by way of the spectral method (SM). the cross-correlation coefficient between Vtwa and VAI is γ = 0.8601. the algorithm can identify the absence and presence of tWA accurately and provide idea for further study of tWA-PM.

关键词： t-wave Alternans Poincare Mapping Method Spectral Method Vector Angle Index (VAI)

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Non-invasive serum potassium concentration measurement in children with CKD by quantifying t-wave morphology dynamics

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EngMedicine 2024年第2期1卷 16-21页

作者： Yue Xi Zhen Liu Jie Ni Yang Miao Zhi Chen Department of Nephrology Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijing100045China Faculty of Materials and Manufacturing Beijing Key Laboratory of Advanced Manufacturing TechnologyBeijing University of TechnologyChina

this study investigated the relationship between electrocardiography(ECG)and serum potassium levels in 100 children aged 6–18 years with chronic kidney disease admitted to the Department of Nephrology,Beijing Children's Hospital Affiliated,Capital Medical University,*** research data were obtained from children in their growth and development stages with significant differences in their physical *** established a promising indicator,ts/a,calculated ts/a for V2–V6 in 100 children,and correlated it with their serum potassium *** significant differences in age and body shape between developing children and adults,the results showed that the ts/a values of V5 and V6 were more strongly correlated with blood potassium values.t wave at the V5 and V6 leads in children can reflect the direction of the primary amplitude of the t-wave and twave downward slope,and the heart space position in the chest characteristics during childhood lead to these *** study provides an essential foundation for the future mobile monitoring of serum potassium levels.

关键词： Children Chronic kidney disease ECG t-wave Hyperkalemia

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