Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification

Abstract Heterogeneity in depolarization and repolarization among regions of cardiac cells has long been recognized as a major factor in cardiac arrhythmogenesis. This fundamental principle has motivated development of noninvasive techniques for quantification of heterogeneity using the surface elec...

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Autores principales:	Richard L. Verrier, Bruce D. Nearing, Andre D’Avila
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	ECG heterogeneity heart failure myocardial ischemia sudden cardiac death risk stratification T‐wave alternans ventricular arrhythmias Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/c5ad1350e292485eb9ff9ad6c358743d
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spelling	oai:doaj.org-article:c5ad1350e292485eb9ff9ad6c358743d2021-11-12T11:40:14ZSpectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification1542-474X1082-720X10.1111/anec.12894https://doaj.org/article/c5ad1350e292485eb9ff9ad6c358743d2021-11-01T00:00:00Zhttps://doi.org/10.1111/anec.12894https://doaj.org/toc/1082-720Xhttps://doaj.org/toc/1542-474XAbstract Heterogeneity in depolarization and repolarization among regions of cardiac cells has long been recognized as a major factor in cardiac arrhythmogenesis. This fundamental principle has motivated development of noninvasive techniques for quantification of heterogeneity using the surface electrocardiogram (ECG). The initial approaches focused on interval analysis such as interlead QT dispersion and Tpeak–Tend difference. However, because of inherent difficulties in measuring the termination point of the T wave and commonly encountered irregularities in the apex of the T wave, additional techniques have been pursued. The newer methods incorporate assessment of the entire morphology of the T wave and in some cases of the R wave as well. This goal has been accomplished using a number of promising vectorial approaches with the resting 12‐lead ECG. An important limitation of vectorcardiographic analyses is that they require exquisite stability of the recordings and are not inherently suitable for use in exercise tolerance testing (ETT) and/or ambulatory ECG monitoring for provocative stress testing or evaluation of the influence of daily activities on cardiac electrical instability. The objectives of the present review are to describe a technique that has been under clinical evaluation for nearly a decade, termed “interlead ECG heterogeneity.” Preclinical testing data will be briefly reviewed. We will discuss the main clinical findings with regard to sudden cardiac death risk stratification, heart failure evaluation, and myocardial ischemia detection using standard recording platforms including resting 12‐lead ECG, ambulatory ECG monitoring, ETT, and pharmacologic stress testing in conjunction with single‐photon emission computed tomography myocardial perfusion imaging.Richard L. VerrierBruce D. NearingAndre D’AvilaWileyarticleECG heterogeneityheart failuremyocardial ischemiasudden cardiac death risk stratificationT‐wave alternansventricular arrhythmiasDiseases of the circulatory (Cardiovascular) systemRC666-701ENAnnals of Noninvasive Electrocardiology, Vol 26, Iss 6, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ECG heterogeneity heart failure myocardial ischemia sudden cardiac death risk stratification T‐wave alternans ventricular arrhythmias Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	ECG heterogeneity heart failure myocardial ischemia sudden cardiac death risk stratification T‐wave alternans ventricular arrhythmias Diseases of the circulatory (Cardiovascular) system RC666-701 Richard L. Verrier Bruce D. Nearing Andre D’Avila Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification
description	Abstract Heterogeneity in depolarization and repolarization among regions of cardiac cells has long been recognized as a major factor in cardiac arrhythmogenesis. This fundamental principle has motivated development of noninvasive techniques for quantification of heterogeneity using the surface electrocardiogram (ECG). The initial approaches focused on interval analysis such as interlead QT dispersion and Tpeak–Tend difference. However, because of inherent difficulties in measuring the termination point of the T wave and commonly encountered irregularities in the apex of the T wave, additional techniques have been pursued. The newer methods incorporate assessment of the entire morphology of the T wave and in some cases of the R wave as well. This goal has been accomplished using a number of promising vectorial approaches with the resting 12‐lead ECG. An important limitation of vectorcardiographic analyses is that they require exquisite stability of the recordings and are not inherently suitable for use in exercise tolerance testing (ETT) and/or ambulatory ECG monitoring for provocative stress testing or evaluation of the influence of daily activities on cardiac electrical instability. The objectives of the present review are to describe a technique that has been under clinical evaluation for nearly a decade, termed “interlead ECG heterogeneity.” Preclinical testing data will be briefly reviewed. We will discuss the main clinical findings with regard to sudden cardiac death risk stratification, heart failure evaluation, and myocardial ischemia detection using standard recording platforms including resting 12‐lead ECG, ambulatory ECG monitoring, ETT, and pharmacologic stress testing in conjunction with single‐photon emission computed tomography myocardial perfusion imaging.
format	article
author	Richard L. Verrier Bruce D. Nearing Andre D’Avila
author_facet	Richard L. Verrier Bruce D. Nearing Andre D’Avila
author_sort	Richard L. Verrier
title	Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification
title_short	Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification
title_full	Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification
title_fullStr	Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification
title_full_unstemmed	Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification
title_sort	spectrum of clinical applications of interlead ecg heterogeneity assessment: from myocardial ischemia detection to sudden cardiac death risk stratification
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/c5ad1350e292485eb9ff9ad6c358743d
work_keys_str_mv	AT richardlverrier spectrumofclinicalapplicationsofinterleadecgheterogeneityassessmentfrommyocardialischemiadetectiontosuddencardiacdeathriskstratification AT brucednearing spectrumofclinicalapplicationsofinterleadecgheterogeneityassessmentfrommyocardialischemiadetectiontosuddencardiacdeathriskstratification AT andredavila spectrumofclinicalapplicationsofinterleadecgheterogeneityassessmentfrommyocardialischemiadetectiontosuddencardiacdeathriskstratification
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Spectrum of clinical applications of interlead ECG heterogeneity assessment: From myocardial ischemia detection to sudden cardiac death risk stratification

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