AuthorsG. T. Lines, B. L. de Oliveira, O. Skavhaug and M. Maleckar
TitleSimple T wave metrics may better predict early ischemia as compared to ST segment
AfilliationScientific Computing
Publication TypeJournal Article
Year of Publication2016
JournalIEEE Transactions on Biomedical Engineering

There is pressing clinical need to identify developing heart attack (infarction) in patients as early as possible. However, current state-of-the-art tools in clinical practice, underpinned by evaluation of elevation of the ST-segment of the 12-lead electrocardiogram, do not identify all patients suffering from lack of blood flow to the heart muscle (cardiac ischemia), worsening the risk for further adverse events and patient outcome overall. In this study, we aimed to explore and compare the portions of cardiac repolarization in the ECG that best capture the electrophysiological changes associated with ischemia. We developed 3D electrophysiological models of the human ventricles and torso, incorporating biophysically-based membrane kinetics and realistic activation sequence, to compute simulated ECGs and their alteration with application of simulated ischemia of differing severity in diverse regions of the heart. Results suggest that metrics based on the T-wave in addition to the ST segment may be more sensitive to detecting ischemia than those using the ST segment alone. Further research into how such simulationaided risk assessment methods may aid workflows in extant clinical practice, with the ultimate goal of multi-modality clinical support, is warranted.