The case of the QRS-T angles versus QRST integral maps

This contribution discusses the QRS-T angle as well as the QRST integral map. Both of these topics have been tested in their application in extracting the major features of depolarization and repolarization: their spatio-temporal behaviour, and how much of their global or local nature might be deduced from signals that can be observed clinically. Recently, it is in particular the QRS-T angle that has received considerable attention, a method that stems directly from vectorcardiography, a subdomain of electrocardiography. The QRST integral map is a display of a map on the body surface of the integrals over time of the ECG signals observed at sets of electrodes. The common biophysical background of both techniques is highlighted. In particular it is explained why, in healthy myocardium, both provide a similar view on the global timing of the depolarization and repolarization of all cardiac myocytes, more specifically, on the dispersion of their action potential durations. In the presence of ischemia, the view obtained is of the integral over time of the transmembrane potentials, which comprises a 'mixture' of their timing and magnitude. The analysis of results of a simulation study emphasizes the large discrepancies that may be observed between the QRS-T angle in the frontal plane and its 3D variant. It is shown that the required vector representation of the signals may be derived from the 12-lead ECG by using the transfer matrix proposed in 1990 by Kors and colleagues.