Importance of the heart vector origin point definition for an ECG analysis

The Atherosclerosis Risk in Communities (ARIC) study

Erick Andres Perez-Alday, Yin Li-Pershing, Aron Bender, Christopher Hamilton, Jason A. Thomas, Kyle Johnson, Tiffany L. Lee, Ryan Gonzales, Aaron Li, Kelley Newton, Larisa Tereshchenko

    Research output: Contribution to journalArticle

    Abstract

    Aim: Our goal was to investigate the effect of a global XYZ median beat construction and the heart vector origin point definition on predictive accuracy of ECG biomarkers of sudden cardiac death (SCD). Methods: Atherosclerosis Risk In Community study participants with analyzable digital ECGs were included (n = 15,768; 55% female, 73% white, mean age 54.2 ± 5.8 y). We developed an algorithm to automatically detect the heart vector origin point on a median beat. Three different approaches to construct a global XYZ beat and two methods to locate origin point were compared. Global electrical heterogeneity was measured by sum absolute QRST integral (SAI QRST), spatial QRS-T angle, and spatial ventricular gradient (SVG) magnitude, azimuth, and elevation. Adjudicated SCD served as the primary outcome. Results: There was high intra-observer (kappa 0.972) and inter-observer (kappa 0.984) agreement in a heart vector origin definition between an automated algorithm and a human. QRS was wider in a median beat that was constructed using R-peak alignment than in time-coherent beat (88.1 ± 16.7 vs. 83.7 ± 15.9 ms; P < 0.0001), and on a median beat constructed using QRS-onset as a zeroed baseline, vs. isoelectric origin point (86.7 ± 15.9 vs. 83.7 ± 15.9 ms; P < 0.0001). ROC AUC was significantly larger for QRS, QT, peak QRS-T angle, SVG elevation, and SAI QRST if measured on a time-coherent median beat, and for SAI QRST and SVG magnitude if measured on a median beat using isoelectric origin point. Conclusion: Time-coherent global XYZ median beat with physiologically meaningful definition of the heart vector's origin point improved predictive accuracy of SCD biomarkers.

    Original languageEnglish (US)
    Pages (from-to)127-138
    Number of pages12
    JournalComputers in Biology and Medicine
    Volume104
    DOIs
    StatePublished - Jan 1 2019

    Fingerprint

    Electrocardiography
    Sudden Cardiac Death
    Atherosclerosis
    Isoelectric Point
    Biomarkers
    Area Under Curve

    Keywords

    • Electrocardiography
    • Electrocardiology
    • Median beat
    • Origin point
    • Sudden cardiac death
    • Vectorcardiogram
    • Vectorcardiography

    ASJC Scopus subject areas

    • Computer Science Applications
    • Health Informatics

    Cite this

    Importance of the heart vector origin point definition for an ECG analysis : The Atherosclerosis Risk in Communities (ARIC) study. / Perez-Alday, Erick Andres; Li-Pershing, Yin; Bender, Aron; Hamilton, Christopher; Thomas, Jason A.; Johnson, Kyle; Lee, Tiffany L.; Gonzales, Ryan; Li, Aaron; Newton, Kelley; Tereshchenko, Larisa.

    In: Computers in Biology and Medicine, Vol. 104, 01.01.2019, p. 127-138.

    Research output: Contribution to journalArticle

    Perez-Alday, EA, Li-Pershing, Y, Bender, A, Hamilton, C, Thomas, JA, Johnson, K, Lee, TL, Gonzales, R, Li, A, Newton, K & Tereshchenko, L 2019, 'Importance of the heart vector origin point definition for an ECG analysis: The Atherosclerosis Risk in Communities (ARIC) study', Computers in Biology and Medicine, vol. 104, pp. 127-138. https://doi.org/10.1016/j.compbiomed.2018.11.013
    Perez-Alday, Erick Andres ; Li-Pershing, Yin ; Bender, Aron ; Hamilton, Christopher ; Thomas, Jason A. ; Johnson, Kyle ; Lee, Tiffany L. ; Gonzales, Ryan ; Li, Aaron ; Newton, Kelley ; Tereshchenko, Larisa. / Importance of the heart vector origin point definition for an ECG analysis : The Atherosclerosis Risk in Communities (ARIC) study. In: Computers in Biology and Medicine. 2019 ; Vol. 104. pp. 127-138.
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    abstract = "Aim: Our goal was to investigate the effect of a global XYZ median beat construction and the heart vector origin point definition on predictive accuracy of ECG biomarkers of sudden cardiac death (SCD). Methods: Atherosclerosis Risk In Community study participants with analyzable digital ECGs were included (n = 15,768; 55{\%} female, 73{\%} white, mean age 54.2 ± 5.8 y). We developed an algorithm to automatically detect the heart vector origin point on a median beat. Three different approaches to construct a global XYZ beat and two methods to locate origin point were compared. Global electrical heterogeneity was measured by sum absolute QRST integral (SAI QRST), spatial QRS-T angle, and spatial ventricular gradient (SVG) magnitude, azimuth, and elevation. Adjudicated SCD served as the primary outcome. Results: There was high intra-observer (kappa 0.972) and inter-observer (kappa 0.984) agreement in a heart vector origin definition between an automated algorithm and a human. QRS was wider in a median beat that was constructed using R-peak alignment than in time-coherent beat (88.1 ± 16.7 vs. 83.7 ± 15.9 ms; P < 0.0001), and on a median beat constructed using QRS-onset as a zeroed baseline, vs. isoelectric origin point (86.7 ± 15.9 vs. 83.7 ± 15.9 ms; P < 0.0001). ROC AUC was significantly larger for QRS, QT, peak QRS-T angle, SVG elevation, and SAI QRST if measured on a time-coherent median beat, and for SAI QRST and SVG magnitude if measured on a median beat using isoelectric origin point. Conclusion: Time-coherent global XYZ median beat with physiologically meaningful definition of the heart vector's origin point improved predictive accuracy of SCD biomarkers.",
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    T2 - The Atherosclerosis Risk in Communities (ARIC) study

    AU - Perez-Alday, Erick Andres

    AU - Li-Pershing, Yin

    AU - Bender, Aron

    AU - Hamilton, Christopher

    AU - Thomas, Jason A.

    AU - Johnson, Kyle

    AU - Lee, Tiffany L.

    AU - Gonzales, Ryan

    AU - Li, Aaron

    AU - Newton, Kelley

    AU - Tereshchenko, Larisa

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    N2 - Aim: Our goal was to investigate the effect of a global XYZ median beat construction and the heart vector origin point definition on predictive accuracy of ECG biomarkers of sudden cardiac death (SCD). Methods: Atherosclerosis Risk In Community study participants with analyzable digital ECGs were included (n = 15,768; 55% female, 73% white, mean age 54.2 ± 5.8 y). We developed an algorithm to automatically detect the heart vector origin point on a median beat. Three different approaches to construct a global XYZ beat and two methods to locate origin point were compared. Global electrical heterogeneity was measured by sum absolute QRST integral (SAI QRST), spatial QRS-T angle, and spatial ventricular gradient (SVG) magnitude, azimuth, and elevation. Adjudicated SCD served as the primary outcome. Results: There was high intra-observer (kappa 0.972) and inter-observer (kappa 0.984) agreement in a heart vector origin definition between an automated algorithm and a human. QRS was wider in a median beat that was constructed using R-peak alignment than in time-coherent beat (88.1 ± 16.7 vs. 83.7 ± 15.9 ms; P < 0.0001), and on a median beat constructed using QRS-onset as a zeroed baseline, vs. isoelectric origin point (86.7 ± 15.9 vs. 83.7 ± 15.9 ms; P < 0.0001). ROC AUC was significantly larger for QRS, QT, peak QRS-T angle, SVG elevation, and SAI QRST if measured on a time-coherent median beat, and for SAI QRST and SVG magnitude if measured on a median beat using isoelectric origin point. Conclusion: Time-coherent global XYZ median beat with physiologically meaningful definition of the heart vector's origin point improved predictive accuracy of SCD biomarkers.

    AB - Aim: Our goal was to investigate the effect of a global XYZ median beat construction and the heart vector origin point definition on predictive accuracy of ECG biomarkers of sudden cardiac death (SCD). Methods: Atherosclerosis Risk In Community study participants with analyzable digital ECGs were included (n = 15,768; 55% female, 73% white, mean age 54.2 ± 5.8 y). We developed an algorithm to automatically detect the heart vector origin point on a median beat. Three different approaches to construct a global XYZ beat and two methods to locate origin point were compared. Global electrical heterogeneity was measured by sum absolute QRST integral (SAI QRST), spatial QRS-T angle, and spatial ventricular gradient (SVG) magnitude, azimuth, and elevation. Adjudicated SCD served as the primary outcome. Results: There was high intra-observer (kappa 0.972) and inter-observer (kappa 0.984) agreement in a heart vector origin definition between an automated algorithm and a human. QRS was wider in a median beat that was constructed using R-peak alignment than in time-coherent beat (88.1 ± 16.7 vs. 83.7 ± 15.9 ms; P < 0.0001), and on a median beat constructed using QRS-onset as a zeroed baseline, vs. isoelectric origin point (86.7 ± 15.9 vs. 83.7 ± 15.9 ms; P < 0.0001). ROC AUC was significantly larger for QRS, QT, peak QRS-T angle, SVG elevation, and SAI QRST if measured on a time-coherent median beat, and for SAI QRST and SVG magnitude if measured on a median beat using isoelectric origin point. Conclusion: Time-coherent global XYZ median beat with physiologically meaningful definition of the heart vector's origin point improved predictive accuracy of SCD biomarkers.

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    KW - Electrocardiology

    KW - Median beat

    KW - Origin point

    KW - Sudden cardiac death

    KW - Vectorcardiogram

    KW - Vectorcardiography

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