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Published in: Journal of Cardiothoracic Surgery 1/2013

Open Access 01-12-2013 | Research article

A combined algorithm for T-wave alternans qualitative detection and quantitative measurement

Authors: XiangKui Wan, Kanghui Yan, Dehan Luo, Yanjun Zeng

Published in: Journal of Cardiothoracic Surgery | Issue 1/2013

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Abstract

Background

T-wave alternans (TWA) provides a noninvasive and clinically useful marker for the risk of sudden cardiac death (SCD). Current most widely used TWA detection algorithms work in two different domains: time and frequency. The disadvantage of the spectral analytical techniques is that they treat the alternans signal as a stationary wave with a constant amplitude and a phase. They cannot detect non-stationary characteristics of the signal. The temporal domain methods are sensitive to the alignment of the T-waves. In this study, we sought to develop a robust combined algorithm (CA) to assess T-wave alternans, which can qualitatively detect and quantitatively measure TWA in time domain.

Methods

The T wave sequences were extracted and the total energy of each T wave within the specified time-frequency region was calculated. The rank-sum test was applied to the ranked energy sequences of T waves to detect TWA qualitatively. The ECG containing TWA was quantitatively analyzed with correlation method.

Results

Simulation test result proved a mean sensitivity of 91.2% in detecting TWA, and for the SNR not less than 30 dB, the accuracy rate of detection achieved 100%. The clinical data experiment showed that the results from this method vs. spectral method had the correlation coefficients of 0.96.

Conclusions

A novel TWA analysis algorithm utilizing the wavelet transform and correlation technique is presented in this paper. TWAs are not only correctly detected qualitatively in frequency domain by energy value of T waves, but the alternans frequency and amplitude in temporal domain are measured quantitatively.
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Literature
1.
go back to reference Bigger JT, Fleiss JL, Kleiger R: The relationship among ventricular arrhythmias, left ventricular dysfunction and mortality in the 2 years after myocardial infarction. Circulation. 1984, 69: 250-258. 10.1161/01.CIR.69.2.250.CrossRefPubMed Bigger JT, Fleiss JL, Kleiger R: The relationship among ventricular arrhythmias, left ventricular dysfunction and mortality in the 2 years after myocardial infarction. Circulation. 1984, 69: 250-258. 10.1161/01.CIR.69.2.250.CrossRefPubMed
2.
go back to reference Echt DS, Liebson PR, Mitchell LB: Mortality and morbidity in patients receiving encainide, flecainide, or placebo. N Engl J Med. 1991, 324: 781-788. 10.1056/NEJM199103213241201.CrossRefPubMed Echt DS, Liebson PR, Mitchell LB: Mortality and morbidity in patients receiving encainide, flecainide, or placebo. N Engl J Med. 1991, 324: 781-788. 10.1056/NEJM199103213241201.CrossRefPubMed
3.
go back to reference Michael JC, David SR: Explaining the clinical manifestations of T wave alternans in patients at risk for sudden cardiac death. Hear Rhythm. 2009, 6: 22-28. 10.1016/j.hrthm.2008.10.007.CrossRef Michael JC, David SR: Explaining the clinical manifestations of T wave alternans in patients at risk for sudden cardiac death. Hear Rhythm. 2009, 6: 22-28. 10.1016/j.hrthm.2008.10.007.CrossRef
4.
go back to reference Gustavo L, Anne BC: Risk stratification for sudden cardiac death: current approaches and predictive value. Curr Cardiol Rev. 2009, 5: 56-64. 10.2174/157340309787048130.CrossRef Gustavo L, Anne BC: Risk stratification for sudden cardiac death: current approaches and predictive value. Curr Cardiol Rev. 2009, 5: 56-64. 10.2174/157340309787048130.CrossRef
5.
go back to reference Moss AJ, Zareba W, Hall WJ: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002, 346: 877-10.1056/NEJMoa013474.CrossRefPubMed Moss AJ, Zareba W, Hall WJ: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002, 346: 877-10.1056/NEJMoa013474.CrossRefPubMed
6.
go back to reference Zareba W, Moss AJ: Noninvasive risk strtification in postinfarction patients with severe left ventricular dysfunction and methodology of the MADIT II noninvasive electrophysiology substudy. J Electocardiol. 2003, 36: 101-108.CrossRef Zareba W, Moss AJ: Noninvasive risk strtification in postinfarction patients with severe left ventricular dysfunction and methodology of the MADIT II noninvasive electrophysiology substudy. J Electocardiol. 2003, 36: 101-108.CrossRef
7.
go back to reference Adam DR, Akselrod S, Cohen RJ: Estimation of ventricular vulnerability to fibrillation through T-wave time series analysis. Comput Cardiol. 1981, 8: 307-310. Adam DR, Akselrod S, Cohen RJ: Estimation of ventricular vulnerability to fibrillation through T-wave time series analysis. Comput Cardiol. 1981, 8: 307-310.
8.
go back to reference Smith JM, Clancy EA, Valeri CR: Electrical alternans and cardiac electrical instability. Circulation. 1988, 77 (1): 110-121. 10.1161/01.CIR.77.1.110.CrossRefPubMed Smith JM, Clancy EA, Valeri CR: Electrical alternans and cardiac electrical instability. Circulation. 1988, 77 (1): 110-121. 10.1161/01.CIR.77.1.110.CrossRefPubMed
9.
go back to reference Nearing BD, Huang AH, Verrier RL: Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave. Science. 1991, 252: 437-440. 10.1126/science.2017682.CrossRefPubMed Nearing BD, Huang AH, Verrier RL: Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave. Science. 1991, 252: 437-440. 10.1126/science.2017682.CrossRefPubMed
10.
go back to reference Laguna P, Ruiz M, Moody GB: Repolarization alternans detection using the KL transform and the beatquency spectrum. Computing in Cardiology. 1996, 23: 673-676. Laguna P, Ruiz M, Moody GB: Repolarization alternans detection using the KL transform and the beatquency spectrum. Computing in Cardiology. 1996, 23: 673-676.
11.
go back to reference Nearing BD, Verrier RL: Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol. 2002, 92: 541-549.CrossRefPubMed Nearing BD, Verrier RL: Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol. 2002, 92: 541-549.CrossRefPubMed
12.
go back to reference Burattini L, Zareba W, Moss AJ: Correlation method for detection of transient T-wave alternans in digital Holter ECG recordings. Annals of Noninvasive. Electrocardiology. 1999, 4 (4): 416-426. Burattini L, Zareba W, Moss AJ: Correlation method for detection of transient T-wave alternans in digital Holter ECG recordings. Annals of Noninvasive. Electrocardiology. 1999, 4 (4): 416-426.
13.
go back to reference Addison PS, Watson JN, Clegg G: Evaluating arrhythmias in ECG signals using wavelet transforms. IEEE Trans Biomed Eng. 2000, 19 (4): 383-392. Addison PS, Watson JN, Clegg G: Evaluating arrhythmias in ECG signals using wavelet transforms. IEEE Trans Biomed Eng. 2000, 19 (4): 383-392.
14.
go back to reference Inaki R, Grubb NR: T-wave alternans found in preventricular tachyarrhythmias in CCU patients using a wavelet transform-based methodology. IEEE Trans Biomed Eng. 2008, 55 (11): 2658-2665.CrossRef Inaki R, Grubb NR: T-wave alternans found in preventricular tachyarrhythmias in CCU patients using a wavelet transform-based methodology. IEEE Trans Biomed Eng. 2008, 55 (11): 2658-2665.CrossRef
15.
go back to reference Addison PS: Wavelet transforms and the ECG: a review. Physiol Meas. 2005, 26 (1): 155-199.CrossRef Addison PS: Wavelet transforms and the ECG: a review. Physiol Meas. 2005, 26 (1): 155-199.CrossRef
16.
go back to reference Ferdjallah M, Barr RE: Adaptive digital notch filter design on the unit circle for the removal of powerline noise from biomedical signals. IEEE Trans Biomed Eng. 1994, 41 (4): 529-536.CrossRefPubMed Ferdjallah M, Barr RE: Adaptive digital notch filter design on the unit circle for the removal of powerline noise from biomedical signals. IEEE Trans Biomed Eng. 1994, 41 (4): 529-536.CrossRefPubMed
17.
go back to reference Wan X, Xu D, Zhang J: Research on ECG de-noising method based on wavelet transform. Chin J Biomed Eng. 2008, 27 (4): 630-632. Wan X, Xu D, Zhang J: Research on ECG de-noising method based on wavelet transform. Chin J Biomed Eng. 2008, 27 (4): 630-632.
18.
go back to reference Martinez JP, Olmos S, Laguna P: T wave alternans detection: a simulation study and analysis of the European ST-T database. Comput Cardiol. 2000, 27: 155-158. Martinez JP, Olmos S, Laguna P: T wave alternans detection: a simulation study and analysis of the European ST-T database. Comput Cardiol. 2000, 27: 155-158.
Metadata
Title
A combined algorithm for T-wave alternans qualitative detection and quantitative measurement
Authors
XiangKui Wan
Kanghui Yan
Dehan Luo
Yanjun Zeng
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2013
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/1749-8090-8-7

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