T-wave Peak-to-End Changes Quantified by Time-Warping Predicts Ventricular Fibrillation in a Porcine Myocardial Infarction Model

Gómez, Neurys ; Ramírez, Julia (Universidad de Zaragoza) ; Martín-Yebra, Alba (Universidad de Zaragoza) ; Demidova, Marina M. ; Platonov, Pyotr ; Martínez, Juan Pablo (Universidad de Zaragoza) ; Laguna, Pablo (Universidad de Zaragoza)

Resumen: Background: The T-peak-to-T-end ( $\mathrm{T}_{pe}$ ) interval has shown potential in predicting ventricular arrhythmic risk. It is an appealing index to be measured during ischemia since it is less influenced by ST-segment changes than the early part of the T wave. A time-warping-based index, derived from a spatially transformed PCA lead, $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ , quantifying changes in the $\mathrm{T}_{pe}$ morphology, has previously demonstrated utility in tracking repolarization changes induced by a 5-minute ischemia model in humans. The value of $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ as a predictor of ventricular fibrillation (VF) episodes is assessed in a porcine model of myocardial ischemia with ischemia maintained for 40 minutes. Methods: From 32 pigs undergoing a coronary occlusion, pre-occlusion and occlusion ECG recordings from 10 pigs suffering a VF episode after 10 min of occlusion (Delayed VF) and 16 that did not had any episode during the recording were analyzed. The $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ series was measured by comparing $\mathrm{T}_{pe}$ morphologies at different stages of the occlusion relative to the peak-to-end morphology of a baseline T-wave. Results: During baseline, $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ remained stationary with an intra-recording median [IQR] value of 1.60 [1.33] ms. During artery occlusion, $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ followed a well-marked gradual increasing trend as ischemia progressed, reaching a median of 14.58 [17.72] ms. $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ averages were significantly higher ( ${p< 0.05}$ ) in the VF group than in the Non-VF group at time intervals 0-5, 5-10, 10-15, 15-20, 20-25 min after occlusion onset and at 10-15, 5-10 and 5-0 minutes prior to VF episode, with median values of 12.5, 18.8, 26.8, 24.0, 31.0, 18.6, 25.0 and 28.8 vs 6.3, 7.6, 8.0, 7.8, 7.8, 8.5, 7.2 and 6.0 ms, respectively. The $\mathrm{T}_{pe}^{\text{PCA}}$ interval was also significantly higher in the VF group at all analyzed time periods, but with a lower significance level. Pigs with maximum $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ $\geq$ 20.0 ms and $\mathrm{T}_{pe}^{\text{PCA}}$ $\geq$ 85.4 ms had significantly higher risk for VF occurring in the early 5-10 minutes interval, with 90.0%/75.0% and 80.0%/69.0% sensitivity/specificity, respectively. Univariate Cox analysis yielded hazard ratios of 12.5 for $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ vs 5.5 for $\mathrm{T}_{pe}^{\text{PCA}}$ . Conclusions and Significance: The time-warping-based index, $d^{{\kern0.28436pt}\text{PCA}}_{w,{\scriptscriptstyle \mathrm{T}_{pe}}}$ , is a stronger VF predictor than $\mathrm{T}_{pe}^{\text{PCA}}$ during ischemia in a porcine model, advising for further clinical exploration studies in humans.

Idioma: Inglés

DOI: 10.1109/TBME.2024.3404254

Año: 2024

Publicado en: IEEE Transactions on Biomedical Engineering 71, 10 (2024), 2968-2977
ISSN: 0018-9294

Financiación: info:eu-repo/grantAgreement/ES/AEI/PID2021-128972OA-I00
Financiación: info:eu-repo/grantAgreement/ES/DGA/MultiMetAr LMP143-21
Financiación: info:eu-repo/grantAgreement/ES/DGA/T39-23R
Financiación: info:eu-repo/grantAgreement/ES/MICINN/PID2019-104881RB-I00
Financiación: info:eu-repo/grantAgreement/ES/MICINN/RYC2021-031413-I
Financiación: info:eu-repo/grantAgreement/EUR/MICINN/TED2021-130459B-I00

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Teoría Señal y Comunicac. (Dpto. Ingeniería Electrón.Com.)