title: Detection and evaluation of ventricular repolarization alternans: an approach to combined ECG, thoracic impedance, and beat-to-beat heart rate variability analysis.
abstract: OBJECTIVE
  Beat-to-beat alteration in ventricles repolarization reflected by alternans of amplitude and/or shape of ECG S-T,T segment (TWA) is known as phenomena related with risk of severe arrhythmias leading to sudden cardiac death. Technical difficulties have caused limited its usage in clinical diagnostics. Possibilities to register and analyze multimodal signals reflecting heart activity inspired search for new technical solutions. First objective of this study was to test whether thoracic impedance signal and beat-to-beat heart rate reflect repolarization alternans detected as TWA. The second objective was revelation of multimodal signal features more comprehensively representing the phenomena and increasing its prognostic usefulness.
  
  
  METHODS
  ECG, and thoracic impedance signal recordings made during 24h follow-up of the patients hospitalized in acute phase of myocardial infarction were used for investigation. Signal morphology variations reflecting estimates were obtained by the principal component analysis-based method. Clinical outcomes of patients (survival and/or rehospitalization in 6 and 12 months) were compared to repolarization alternans and heart rate variability estimates.
  
  
  RESULTS
  Repolarization alternans detected as TWA was also reflected in estimates of thoracic impedance signal shape and variation in beat-to-beat heart rate. All these parameters showed correlation with clinical outcomes of patients. The strongest significant correlation showed magnitude of alternans in estimates of thoracic impedance signal shape.
  
  
  CONCLUSIONS
  The features of ECG, thoracic impedance signal and beat-to-beat variability of heart rate, give comprehensive estimates of repolarization alternans, which correlate, with clinical outcomes of the patients and we recommend using them to improve diagnostic reliability.
authors.affiliation: Department of Physics, Mathematics and Biophysics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Kaunas University of Technology, Kaunas, Lithuania. Electronic address: algimantas.krisciukaitis@lsmuni.lt.
authors.forename: Algimantas
authors.initials: A
authors.lastname: Kriščiukaitis
authors.affiliation: Department of Physics, Mathematics and Biophysics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Renata
authors.initials: R
authors.lastname: Šimoliūnienė
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Andrius
authors.initials: A
authors.lastname: Macas
authors.affiliation: Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Robertas
authors.initials: R
authors.lastname: Petrolis
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania.
authors.forename: Kęstutis
authors.initials: K
authors.lastname: Drėgūnas
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Giedrė
authors.initials: G
authors.lastname: Bakšytė
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Linas
authors.initials: L
authors.lastname: Pieteris
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Zita
authors.initials: Z
authors.lastname: Bertašienė
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Remigijus
authors.initials: R
authors.lastname: Žaliūnas
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology; D017097:Electric Impedance; D004562:Electrocardiography / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D015203:Reproducibility of Results; D016276:Ventricular Function
keywords: Principal component analysis; T-wave alternans; Thoracic impedance signal