Post-Ventricular Premature Contraction Phase Correction Improves the Predictive Value of Average T-Wave Alternans in Ambulatory ECG Recordings
| Autor: | Antoni Bayes-de-Luna, Iwona Cygankiewicz, Enrico G. Caiani, Alba Martin-Yebra, Juan Pablo Martinez, Violeta Monasterio, Pablo Laguna |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty 0206 medical engineering Biomedical Engineering 02 engineering and technology 030204 cardiovascular system & hematology Sudden cardiac death 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Heart rate variability Humans Aged medicine.diagnostic_test business.industry Hazard ratio Signal Processing Computer-Assisted T wave alternans Middle Aged medicine.disease Prognosis 020601 biomedical engineering Ventricular Premature Complexes Ambulatory ECG Death Sudden Cardiac Predictive value of tests Heart failure Cardiology Electrocardiography Ambulatory Female business Electrocardiography |
| Zdroj: | IEEE Transactions on Biomedical Engineering |
| ISSN: | 1558-2531 |
| Popis: | Objective : We proposed and evaluated a method for correcting possible phase shifts provoked by the presence of ventricular premature contractions (VPCs) for a better assessment of T-wave alternans (TWA). Methods: First, we synthesized ECG signals with artificial TWA in the presence of different noise sources. Then, we assessed the prognostic value for sudden cardiac death (SCD) of the long-term average of TWA amplitude (the index of average alternans, $IAA$ ) in ambulatory ECG signals from congestive heart failure (CHF) and evaluated whether it is sensitive to the presence of VPCs. Results: The inclusion of the phase correction after VPC in the processing always improved estimation accuracy of the $IAA$ under different noisy conditions and regardless of the number of the VPCs included in the sequence. It also presented a positive impact on the prognostic value of $IAA$ with increased hazard ratios (from 17% to 29%, depending of the scenario) in comparison to the noninclusion of this step. Conclusion: The proposed methodology for $IAA$ estimation, which corrects for the possible phase reversal on TWA after the presence of VPCs, represents a robust TWA estimation approach with a significant impact on the prognostic value of $IAA$ for SCD stratification in CHF patients. Significance: An accurate TWA estimation has a potential direct clinical impact on noninvasive SCD stratification, allowing better identification of patients at higher risk and helping clinicians in adopting the most appropriate therapeutic strategy. |
| Databáze: | OpenAIRE |
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