Enhanced adaptive matched filter for automated identification and measurement of electrocardiographic alternans. (July 2021)

• Record Type: Journal Article
• Authors: Marcantoni, Ilaria; Sbrollini, Agnese; Morettini, Micaela; Swenne, Cees A.; Burattini, Laura
• Is Part Of: Biomedical signal processing and control. Volume 68(2021)
• Publication Date: 2021-07
• Subjects: AAm alternans amplitude -- AAr alternans area -- EAMF enhanced adaptive matched filter -- ECG electrocardiogram -- ECGA electrocardiographic alternans -- fA alternans frequency -- ICD implanted cardioverter defibrillator -- iqr interquartile range -- J J point -- mRR mean RR interval -- NHB number of heartbeats -- NS number of seconds -- Pon P-wave onset -- PWA P-wave alternans -- Qon Q-wave onset -- QRSA QRS-complex alternans -- SF sampling frequency -- stdRR RR standard deviation -- Tend T-wave end -- TWA T-wave alternans; Heart electrical instability -- Cardiac risk index -- Digital electrocardiogram processing -- P-wave alternans -- QRS-complex alternans -- T-wave alternans; Signal processing -- Periodicals; Biomedical engineering -- Periodicals; Signal Processing, Computer-Assisted -- Periodicals; Image Processing, Computer-Assisted -- Periodicals; Biomedical Engineering -- Periodicals; 610.28
• DOI: 10.1016/j.bspc.2021.102619
• Languages: English
• ISSNs: 1746-8094

Abstract

Graphical abstract: Highlights: Electrocardiographic alternans includes P-wave, QRS-complex and T-wave alternans. T-wave alternans is an index of cardiac risk. Our method only automatically identifies all electrocardiographic alternans. Our method proved to be reliable on simulated and experimental data. Our method might increment prognostic value of electrocardiographic alternans. Abstract: Electrocardiographic alternans, consisting of P-wave alternans (PWA), QRS-complex alternans (QRSA) and T-wave alternans (TWA), is an index of cardiac risk. However, only automated TWA measurement methods have been proposed so far. Here, we presented the enhanced adaptive matched filter (EAMF) method and tested its reliability in both simulated and experimental conditions. Our methodological novelty consists in the introduction of a signal enhancement procedure according to which all sections of the electrocardiogram (ECG) but the wave of interest are set to baseline, and in the extraction of the alternans area (AAr) in addition to the standard alternans amplitude (AAm). Simulated data consisted of 27 simulated ECGs representing all combinations of PWA, QRSA and TWA of low (10 μV) and high (100 μV) amplitude. Experimental data consisted of exercise 12-lead ECGs from 266 heart failure patients with an implanted cardioverter defibrillator for primary prevention. EAMF was able to accurately identify and measure all kinds of simulated alternans (absolute maximum error equal to 2%). Moreover, different alternans kinds were simultaneously present in the experimental data and EAMF was able to identify and measure all of them (AAr: 545 μV × ms, 762 μV × ms and 1382 μV × ms; AAm: 5 μV, 9 μV and 7 μV; for PWA, QRSA and TWA, respectively) and to discriminate TWA as the prevalent one (with the highest AAr). EAMF accurately identifies and measures all kinds of electrocardiographic alternans. EAMF may support determination of incremental clinical utility of PWA and QRSA with respect to TWA only.