Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explore...Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.展开更多
Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE...Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.展开更多
T-wave alternans(TWA)refers to the periodic beat-to-beat variation in the amplitude of T-wave in the electrocardiogram(ECG)signal in an ABAB-pattern.TWA has been proven to be a very important indicator of malignant ar...T-wave alternans(TWA)refers to the periodic beat-to-beat variation in the amplitude of T-wave in the electrocardiogram(ECG)signal in an ABAB-pattern.TWA has been proven to be a very important indicator of malignant arrhythmia risk stratification.A new method to detect TWA by combining fractional Fourier transform(FRFT)and tensor decomposition is proposed.First,the T-wave vector is extracted from the ECG of each heartbeat,and its FRFT amplitudes at multiple orders are arranged to form a T-wave matrix.Then,a third-order tensor is composed of T-wave matrices of several consecutive heart beats.After tensor decomposition,projection matrices are obtained in three dimensions.The complexity of the projection matrix is measured by Shannon entropy to obtain feature vector to detect the presence of TWA.Results show that the sensitivity,specificity,and accuracy of the algorithm on the MIT-BIH database are 91.16%,94.25%,and 92.68%,respectively.This method effectively utilizes the fractional domain information of ECG,and shows the promising potential of the FRFT in ECG signal processing.展开更多
T-wave alternans (TWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (T-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a...T-wave alternans (TWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (T-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a frequency component, termed fTWA, that matches half heart rate. The heart-rate adaptive match filter (AMF) based method is a technique for automatic TWA identification from the digital ECG. Aim of the present study was to provide a complete technical description of the filter able to explain its methodological principles. The AMF is usually realized as a 6th order Butterworth filter with a narrow (0.12 Hz) passing band centered in fTWA. It is applied in a bidirectional fashion, so that final filtering order is 12. While extracting the TWA component, the AMF simultaneously filters out every ECG component including noise and artefacts, and thus results are very robust. Goodness of the technique was tested using 8 synthetic ECG tracings corrupted by typical noisy factors, such as white random noise, baseline wanderings, heart-rate variability, and others. Six ECG tracings were affected by 100 μV TWA, whereas two were not. Results indicate that the AMF-based method is able to prevent false-positive and false-negative detections and, thus, represents a useful tool for a reliable TWA identification.展开更多
Presently T-wave alternans (TWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting T-wave alternate accurately is particularly important. This paper introduces an a...Presently T-wave alternans (TWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting T-wave alternate accurately is particularly important. This paper introduces an algorithm for detecting TWA using Poincare mapping method which is a technique for nonlinear dynamic systems to display periodic behavior. Sample series of beat to beat cycles were selected to prepare Poincare mapping method. Vector Angle Index (VAI), which is the mean of the difference between θi (the angle between the line connecting the i point to the origin and the X axis) and 45 degrees was used to present the presence or absence of TWA. The value of 0.9 rad ≤ VAI ≤ 1.03 rad is accepted as a level determinative for presence of TWA. VAI via Poincare mapping method (PM) is used for correlation analysis with T-wave alternans voltage (Vtwa) by way of the spectral method (SM). The cross-correlation coefficient between Vtwa and VAI is γ = 0.8601. The algorithm can identify the absence and presence of TWA accurately and provide idea for further study of TWA-PM.展开更多
Objective: To explore the application value of electrocardiograph (ECG) T-wave Alternans (TWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients who...Objective: To explore the application value of electrocardiograph (ECG) T-wave Alternans (TWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients whose conventional 12-lead ECG has TWA in our hospital from January 2011 to December 2015, 751 patients without TWA in the same period as the control group, compared the volume of intracerebral hemorrhage, bleeding site and mortality between the 2 groups. Results: In TWA group, 247 cases died, 361 cases with massive intracerebral hemorrhage, 298 cases with brain stem hemorrhage;in TWA negative group (control group), 41 cases died, 93 cases with massive brain hemorrhage, 64 cases with brain stem hemorrhage. There are statistical differences between two groups (P Conclusion: The occurrence of TWA is significantly related to the volume of bleeding, the bleeding site and mortality, and can be used as an important parameter in the prognosis of intracerebral hemorrhage.展开更多
T-wave alternans （TWA） in surface electrocardiograph （ECG） signal is considered a marker of abnormal ventricular function which may be associated with ventricular tachy- cardia. Several methods have been developed...T-wave alternans （TWA） in surface electrocardiograph （ECG） signal is considered a marker of abnormal ventricular function which may be associated with ventricular tachy- cardia. Several methods have been developed in recent years to evaluate the important feature. One such method is known as modified moving average （MMA） analysis, which performs well for different levels of TWA, but it is sensitive to the noise in T-waves. In this paper we propose an improved MMA algorithm, which adds a stage of T-wave curve fitting for the MMA method before intermediate averaging. The curve fitting is performed by means of least square method technique. Our assessment study demon- strates the improved performance.展开更多
目的探讨高强度训练对武警战士心律失常的影响。方法选择128名参加任职强化训练的武警战士为训练组,144名同一部队日常基础训练的战士为对照组,利用动态心电图进行心率、心律失常情况及微伏级T波电交替(microvolt T wave alternans,MTWA...目的探讨高强度训练对武警战士心律失常的影响。方法选择128名参加任职强化训练的武警战士为训练组,144名同一部队日常基础训练的战士为对照组,利用动态心电图进行心率、心律失常情况及微伏级T波电交替(microvolt T wave alternans,MTWA)等指标变化的分析。结果训练组平均心率[(77.15±8.85)次/min]、最快心率[(149.10±17.93)次/min]和最慢心率[(59.67±10.50)次/min]均加快(均P<0.05);室性及房性心律失常的发生率和平均数量有升高的趋势且高于对照组(P<0.05);早晨9:00及最快心率时MTWA均高于对照组(均P<0.05)。结论高强度训练应激状态下,武警战士发生心律失常的情况增多,心脏自主神经功能异常导致心肌细胞电活动不稳定,是心律失常的重要原因之一。展开更多
基金the National Natural Science Foundation of China (No. 81470457)the Frontier Technology of Jiangsu Provincial Science and Technology Department (No. BE2016764).
文摘Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.
基金This work was supported by Beijing Municipal Science&Technology Commission(No.Z191100006619007)Beijing Municipal Administration of Hospitals’Ascent Plan(DFL20190902)of Professor Ping Zhang.
文摘Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.
基金supported by the National Natural Science Found-ation of China(No.61701028).
文摘T-wave alternans(TWA)refers to the periodic beat-to-beat variation in the amplitude of T-wave in the electrocardiogram(ECG)signal in an ABAB-pattern.TWA has been proven to be a very important indicator of malignant arrhythmia risk stratification.A new method to detect TWA by combining fractional Fourier transform(FRFT)and tensor decomposition is proposed.First,the T-wave vector is extracted from the ECG of each heartbeat,and its FRFT amplitudes at multiple orders are arranged to form a T-wave matrix.Then,a third-order tensor is composed of T-wave matrices of several consecutive heart beats.After tensor decomposition,projection matrices are obtained in three dimensions.The complexity of the projection matrix is measured by Shannon entropy to obtain feature vector to detect the presence of TWA.Results show that the sensitivity,specificity,and accuracy of the algorithm on the MIT-BIH database are 91.16%,94.25%,and 92.68%,respectively.This method effectively utilizes the fractional domain information of ECG,and shows the promising potential of the FRFT in ECG signal processing.
文摘T-wave alternans (TWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (T-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a frequency component, termed fTWA, that matches half heart rate. The heart-rate adaptive match filter (AMF) based method is a technique for automatic TWA identification from the digital ECG. Aim of the present study was to provide a complete technical description of the filter able to explain its methodological principles. The AMF is usually realized as a 6th order Butterworth filter with a narrow (0.12 Hz) passing band centered in fTWA. It is applied in a bidirectional fashion, so that final filtering order is 12. While extracting the TWA component, the AMF simultaneously filters out every ECG component including noise and artefacts, and thus results are very robust. Goodness of the technique was tested using 8 synthetic ECG tracings corrupted by typical noisy factors, such as white random noise, baseline wanderings, heart-rate variability, and others. Six ECG tracings were affected by 100 μV TWA, whereas two were not. Results indicate that the AMF-based method is able to prevent false-positive and false-negative detections and, thus, represents a useful tool for a reliable TWA identification.
文摘Presently T-wave alternans (TWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting T-wave alternate accurately is particularly important. This paper introduces an algorithm for detecting TWA using Poincare mapping method which is a technique for nonlinear dynamic systems to display periodic behavior. Sample series of beat to beat cycles were selected to prepare Poincare mapping method. Vector Angle Index (VAI), which is the mean of the difference between θi (the angle between the line connecting the i point to the origin and the X axis) and 45 degrees was used to present the presence or absence of TWA. The value of 0.9 rad ≤ VAI ≤ 1.03 rad is accepted as a level determinative for presence of TWA. VAI via Poincare mapping method (PM) is used for correlation analysis with T-wave alternans voltage (Vtwa) by way of the spectral method (SM). The cross-correlation coefficient between Vtwa and VAI is γ = 0.8601. The algorithm can identify the absence and presence of TWA accurately and provide idea for further study of TWA-PM.
文摘Objective: To explore the application value of electrocardiograph (ECG) T-wave Alternans (TWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients whose conventional 12-lead ECG has TWA in our hospital from January 2011 to December 2015, 751 patients without TWA in the same period as the control group, compared the volume of intracerebral hemorrhage, bleeding site and mortality between the 2 groups. Results: In TWA group, 247 cases died, 361 cases with massive intracerebral hemorrhage, 298 cases with brain stem hemorrhage;in TWA negative group (control group), 41 cases died, 93 cases with massive brain hemorrhage, 64 cases with brain stem hemorrhage. There are statistical differences between two groups (P Conclusion: The occurrence of TWA is significantly related to the volume of bleeding, the bleeding site and mortality, and can be used as an important parameter in the prognosis of intracerebral hemorrhage.
文摘T-wave alternans （TWA） in surface electrocardiograph （ECG） signal is considered a marker of abnormal ventricular function which may be associated with ventricular tachy- cardia. Several methods have been developed in recent years to evaluate the important feature. One such method is known as modified moving average （MMA） analysis, which performs well for different levels of TWA, but it is sensitive to the noise in T-waves. In this paper we propose an improved MMA algorithm, which adds a stage of T-wave curve fitting for the MMA method before intermediate averaging. The curve fitting is performed by means of least square method technique. Our assessment study demon- strates the improved performance.
文摘目的探讨高强度训练对武警战士心律失常的影响。方法选择128名参加任职强化训练的武警战士为训练组,144名同一部队日常基础训练的战士为对照组,利用动态心电图进行心率、心律失常情况及微伏级T波电交替(microvolt T wave alternans,MTWA)等指标变化的分析。结果训练组平均心率[(77.15±8.85)次/min]、最快心率[(149.10±17.93)次/min]和最慢心率[(59.67±10.50)次/min]均加快(均P<0.05);室性及房性心律失常的发生率和平均数量有升高的趋势且高于对照组(P<0.05);早晨9:00及最快心率时MTWA均高于对照组(均P<0.05)。结论高强度训练应激状态下,武警战士发生心律失常的情况增多,心脏自主神经功能异常导致心肌细胞电活动不稳定,是心律失常的重要原因之一。
