Comparative Study of Local and Karhunen–Loève-Based ST–T Indexes in Recordings from Human Subjects with Induced Myocardial Ischemia

Abstract

In this work we studied ST–T complex changes in the ECG as result of induced ischemia. The principal aim was to determine whether global changes in the ST–T complex were more sensitive markers of ischemic alterations than those based on measurements of changes at specific locations on ST segment or T wave. High-resolution ECGs from patients undergoing percutaneous transluminal coronary angioplasty in one of the major coronary arteries were analyzed to give a description of the period from the end of active depolarization (QRS complex) to the end of active repolarization (T wave). During artery occlusion traditional local measurements of the ST–T complex were compared to global measurements based on the Karhunen–Loève transform. An ischemic change sensor parameter was estimated for each of the studied indexes showing that global measurements detected changes better in the repolarization period in a larger number of leads and with higher sensitivity (more than 85%) than was done using local measurements (sensitivity of 64% with ST level, 33% with T-wave maximum position, and 37% with T-wave maximum amplitude). Using these global indexes it was found that most cases of ST-segment changes were accompanied by T-wave changes (72% of patients). With the use of traditional indexes 23% of patients showed no changes in the repolarization period, whereas with global indexes this percentage decreased to 8%. Thus a global representation of the entire ST–T complex appears to be more suitable than local measurements when studying the initial stages of myocardial ischemia.