Karhunen-Loève transform as a tool to analyze the ST-segment. Comparison with QT interval

The spatial and temporal courses of ventricular repolarization are quite sensitive to the biochemical and biophysiologic environment of the myocardial cells, and are therefore often an early marker of heart disease, particularly of ischemia. The detailed morphology of the surface electrocardiogram contains considerable information about the repolarization process. The ST-segment changes with ischemia, injury, and drugs. The QT interval is affected by drugs, heart rate, and autonomic tone, and in some situations may identify individuals at high risk for arrhythmias and sudden death. Variability in the shape, including duration, of the ST-T waves reflects autonomic nervous system activity and may identify high-risk patients. Automated methods for quantitatively characterizing ST-T complexes are important in studying long-term electrocardiographic records. Two computer-based measurement procedures for characterizing the repolarization period were comparatively analyzed: Karhunen-Loève (KL) transform representation of the ST-T shape and measurement of beat-to beat durations of repolarization (QT intervals). The results of KL transform representation and time-domain QT measurement algorithms for studying the repolarization period of the electrocardiogram on the European ST-T database are presented. It was found that about 20% of the records present a quasiperiodic KL pattern of ischemic ST-T activity and another 20% exhibit repetitive but not clearly periodic patterns of ischemic ST-T changes. From these ischemic records, 50% showed QT variations in at least one lead associated with the ischemic episodes.