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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Detection and evaluation of ventricular repolarization alternans: An approach to combined ECG, thoracic impedance, and beat-to-beat heart rate variability analysis

1
Department of Physics, Mathematics and Biophysics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
2
Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
3
Kaunas University of Technology, Kaunas, Lithuania
4
Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
5
Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania
6
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2014, 50(6), 345-352; https://doi.org/10.1016/j.medici.2014.11.004
Received: 18 February 2013 / Accepted: 18 November 2014 / Published: 27 November 2014
Background and objective: Beat-to-beat alteration in ventricles repolarization reflected by alternans of amplitude and/or shape of ECG S-T,T segment (TWA) is known as phenomena related with risk of severe arrhythmias leading to sudden cardiac death. Technical difficulties have caused limited its usage in clinical diagnostics. Possibilities to register and analyze multimodal signals reflecting heart activity inspired search for new technical solutions. First objective of this study was to test whether thoracic impedance signal and beat-to-beat heart rate reflect repolarization alternans detected as TWA. The second objective was revelation of multimodal signal features more comprehensively representing the phenomena and increasing its prognostic usefulness.
Materials and methods: ECG, and thoracic impedance signal recordings made during 24 h follow-up of the patients hospitalized in acute phase of myocardial infarction were used for investigation. Signal morphology variations reflecting estimates were obtained by the principal component analysis-based method. Clinical outcomes of patients (survival and/ or rehospitalization in 6 and 12 months) were compared to repolarization alternans and heart rate variability estimates.
Results: Repolarization alternans detected as TWA was also reflected in estimates of thoracic impedance signal shape and variation in beat-to-beat heart rate. All these parameters showed correlation with clinical outcomes of patients. The strongest significant correlation showed magnitude of alternans in estimates of thoracic impedance signal shape.
Conclusions: The features of ECG, thoracic impedance signal and beat-to-beat variability of heart rate, give comprehensive estimates of repolarization alternans, which correlate, with clinical outcomes of the patients and we recommend using them to improve diagnostic reliability.
Keywords: Thoracic impedance signal; T-wave alternans; Principal component analysis Thoracic impedance signal; T-wave alternans; Principal component analysis
MDPI and ACS Style

Kriščiukaitis, A.; Šimoliūnienė, R.; Macas, A.; Petrolis, R.; Drėgūnas, K.; Bakšytė, G.; Pieteris, L.; Bertašienė, Z.; Žaliūnas, R. Detection and evaluation of ventricular repolarization alternans: An approach to combined ECG, thoracic impedance, and beat-to-beat heart rate variability analysis. Medicina 2014, 50, 345-352.

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