Prognostic Role of Electrocardiographic Alternans in Ischemic Heart Disease
Ilaria Marcantoni1, Erica Iammarino1, Alessandro Dell'Orletta1
1Department of Information Engineering, Engineering Faculty, Università Politecnica delle Marche, 60131 Ancona, Italy.
Insights
Electrocardiogram alternans (ECGA) can detect ischemic coronary artery occlusion during balloon inflation in patients with ischemic heart disease. This noninvasive electrical risk index shows promise for improving arrhythmic risk stratification.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Diagnostics
Background:
- Noninvasive arrhythmic risk stratification in ischemic heart disease (IHD) is currently inadequate.
- Electrocardiogram (ECG) analysis, specifically ECG alternans (ECGA), offers a potential avenue for improved risk assessment.
- Further research is needed to validate ECGA's role in IHD.
Purpose of the Study:
- To monitor ECG evidence of ischemic coronary artery occlusion using ECGA.
- To assess ECGA's ability to track the duration of balloon inflation during coronary artery procedures.
- To explore the prognostic value of ECGA as a noninvasive electrical risk index in IHD.
Main Methods:
- ECGA amplitude and magnitude were calculated using the correlation method (CM).
- Data were sourced from the STAFF III database, simulating ischemic coronary artery occlusion via controlled balloon inflation.
- ECGA was measured during, before, and after balloon inflation periods.
Main Results:
- ECGA values were statistically significantly higher during balloon inflation compared to the pre-inflation period.
- ECGA values demonstrated an increasing trend with longer inflation times.
- ECGA measurements during inflation (5-9 µV amplitude, 208-573 µV·beat magnitude) were significantly elevated compared to pre-inflation levels (4-7 µV amplitude, 169-396 µV·beat magnitude).
Conclusions:
- Correlation method-based ECGA detection successfully tracked the balloon inflation period.
- ECGA shows potential as a noninvasive electrical risk index for ischemic heart disease.
- This study contributes to understanding ECGA's prognostic role in IHD patients.
Abstract:
Background/Objectives: Noninvasive arrhythmic risk stratification in patients with ischemic heart disease is poor nowadays, and further investigations are needed. The most correct approach is based on the use of electrocardiogram (ECG) with the extraction of indices such as ECG alternans (ECGA). The aim of this study is to monitor the ECG evidence of ischemic coronary artery occlusion by the ECGA and to verify its ability to monitor the time course of balloon inflation, with the final goal of contributing to the exploration of the prognostic role of ECGA in ischemic heart disease. Methods: The ECGA amplitude and magnitude were computed by the correlation method (CM) on the STAFF III database, where ischemic coronary artery occlusion was induced in a controlled manner through coronary artery blockage by balloon inflation. ECGA computed during balloon inflation was also compared with periods before and after the inflation. Results: ECGA values became statistically higher during inflation than in the pre-inflation period and increased as inflation time increased, although not always in a statistically significant manner. ECGA went from values in the range 4-7 µV and 169-396 µV·beat before inflation to values in the range 5-9 µV and 208-573 µV·beat during 5 min of inflation (resulting statistically higher than before inflation), returning towards values in the range 4-8 µV and 182-360 µV·beat after inflation for amplitude and magnitude, respectively. Conclusions: CM-based ECGA detection was able to track the balloon inflation period. Our ECGA investigation represents a contribution in the field of research exploring its prognostic role as a noninvasive electrical risk index in ischemic heart disease.
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