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Front. Physiol. | doi: 10.3389/fphys.2019.00934

Detection of T wave peak for serial comparisons of JTp interval

Katerina Hnatkova1,  Jose Vicente2, Lars Johannesen2, Christine Garnett2, David G. Strauss2, Norman Stockbridge2 and  Marek Malik1*
  • 1Imperial College London, United Kingdom
  • 2United States Food and Drug Administration, United States

Electrocardiogram (ECG) studies of drug-induced prolongation of the interval between the J point and the peak of the T wave (JTp interval) distinguished QT prolonging drugs that predominantly block the delayed potassium rectifier current from those affecting multiple cardiac repolarisation ion channel currents. Since the peak of the T wave depends on ECG lead, a “global” T peak requires to combine ECG leads into one-dimensional signal in which the T wave peak can be measured. This study aimed at finding the optimum one-dimensional representation of 12-lead ECGs for the most stable JTp measurements. Seven different one-dimensional representations were investigated including the vector magnitude of the orthogonal XYZ transformation, root mean square of all 12 ECG leads, and the vector magnitude of the 3 dominant orthogonal leads derived by singular value decomposition. All representations were applied to the representative waveforms of 660,657 separate 10-second 12-lead ECGs taken from repeated day-time Holter recordings in 523 healthy subjects aged 33.5±8.4 years (254 women). The JTp measurements were compared with the QT intervals and with the intervals between the J point and the median point of the area under the T wave one-dimensional representation (JT50 intervals) by means of calculating the residuals of the subject-specific curvilinear regression models relating the measured interval to the hysteresis-corrected RR interval of the underlying heart rate. The residuals of the regression models (equal to the intra-subject standard deviations of individually heart rate corrected intervals) expressed intra-subject stability of interval measurements. For both the JTp intervals and the JT50 intervals, the curvilinear regression residuals of measurements derived from the orthogonal XYZ representation were marginally but statistically significantly lower compared to the other representations. Using the XYZ representation, the residuals of the QT/RR, JTp/RR and JT50/RR regressions were 5.6±1.1 ms, 7.2±2.2 ms, and 4.9±1.2 ms, respectively (all statistically significantly different; p<0.0001). The study concludes that the orthogonal XYZ ECG representation might be proposed for future investigations of JTp and JT50 intervals. If the ability of classifying QT prolonging drugs is further confirmed for the JT50 interval, it might be appropriate to replace the JTp interval since it appears more stable.

Keywords: JTp interval prolongation, T wave peak measurement, one-dimensional ECG representation, intra-subject stability of rate corrected ECG intervals, normal healthy subjects

Received: 17 Apr 2019; Accepted: 09 Jul 2019.

Edited by:

Tobias Opthof, Academic Medical Center (AMC), Netherlands

Reviewed by:

Ruben Coronel, University of Amsterdam, Netherlands
Jan Kors, Department of Medical Informatics, Erasmus University Medical Center, Netherlands  

Copyright: © 2019 Hnatkova, Vicente, Johannesen, Garnett, Strauss, Stockbridge and Malik. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Marek Malik, Imperial College London, London, SW7 2AZ, United Kingdom, marek.malik@imperial.ac.uk