QRS Slopes for Detection and Characterization of Myocardial Ischemia

In this study, the upward (I US ) and downward (I DS ) slopes of the QRS complex are proposed as indices for quantifying ischemia-induced electrocardiogram (ECG) changes. Using ECG recordings acquired before and during percutaneous transluminal coronary angioplasty (PTCA), it is found that the QRS s...

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Bibliographic Details
Published in:IEEE transactions on biomedical engineering 2008-02, Vol.55 (2), p.468-477
Main Authors: Pueyo, Esther, Sornmo, Leif, Laguna, Pablo
Format: Article
Language:English
Subjects:
Algorithms
Angioplasty
Angioplasty, Balloon
Arterial occlusion
Arteries
Biomedical engineering
Blood flow
Cells (biology)
Communications technology
Computer simulation
Depolarization
Diagnosis, Computer-Assisted - methods
Electrocardiography
Electrocardiography - methods
Frequency
Frequency bands
Heart attacks
high frequency
Humans
Ischemia
Ischemic pain
Myocardial Ischemia - diagnosis
Myocardial Ischemia - surgery
Myocardium
percutaneous transluminal coronary angioplasty (PTCA)
Prognosis
QRS complex
Recording
Reduction
Reproducibility of Results
Sensitivity and Specificity
Slopes
Treatment Outcome
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Summary:In this study, the upward (I US ) and downward (I DS ) slopes of the QRS complex are proposed as indices for quantifying ischemia-induced electrocardiogram (ECG) changes. Using ECG recordings acquired before and during percutaneous transluminal coronary angioplasty (PTCA), it is found that the QRS slopes are considerably less steep during artery occlusion, in particular for I DS . With respect to ischemia detection, the slope indices outperform the often used high-frequency index (defined as the root mean square (rms) of the bandpass-filtered QRS signal for the frequency band 150-250 Hz) as the mean relative factors of change are much larger for I US and I DS than for the high-frequency index (6.9 and 7.3 versus 3.7). The superior performance of the slope indices is equally valid when other frequency bands of the high-frequency index are investigated (the optimum one is found to be 125-175 Hz). Employing a simulation model in which the slopes of a template QRS are altered by different techniques, it is found that the slope changes observed during PTCA are mostly due to a widening of the QRS complex or a decrease of its amplitudes, but not a reduction of its high-frequency content or a combination of this and the previous effects. It is concluded that QRS slope information can be used as an adjunct to the conventional ST segment analysis in the monitoring of myocardial ischemia.
ISSN:0018-9294
1558-2531
DOI:10.1109/TBME.2007.902228