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Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals

The electrocardiographic (ECG) assessment of the T peak–T end (Tpe) intervals has been used in many clinical studies, but several related physiological aspects have not been reported. Specifically, the sources of the Tpe differences between different ECG leads have not been systematically researched...

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Autores principales: Andršová, Irena, Hnatkova, Katerina, Šišáková, Martina, Toman, Ondřej, Smetana, Peter, Huster, Katharina M., Barthel, Petra, Novotný, Tomáš, Schmidt, Georg, Malik, Marek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769826/
https://www.ncbi.nlm.nih.gov/pubmed/33384609
http://dx.doi.org/10.3389/fphys.2020.595815
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author Andršová, Irena
Hnatkova, Katerina
Šišáková, Martina
Toman, Ondřej
Smetana, Peter
Huster, Katharina M.
Barthel, Petra
Novotný, Tomáš
Schmidt, Georg
Malik, Marek
author_facet Andršová, Irena
Hnatkova, Katerina
Šišáková, Martina
Toman, Ondřej
Smetana, Peter
Huster, Katharina M.
Barthel, Petra
Novotný, Tomáš
Schmidt, Georg
Malik, Marek
author_sort Andršová, Irena
collection PubMed
description The electrocardiographic (ECG) assessment of the T peak–T end (Tpe) intervals has been used in many clinical studies, but several related physiological aspects have not been reported. Specifically, the sources of the Tpe differences between different ECG leads have not been systematically researched, the relationship of Tpe duration to underlying heart rate has not been firmly established, and little is known about the mutual correspondence of Tpe intervals measured in different ECG leads. This study evaluated 796,620 10-s 12-lead ECGs obtained from long-term Holters recorded in 639 healthy subjects (311 female) aged 33.8 ± 9.4 years. For each ECG, transformation to orthogonal XYZ lead was used to measure Tpe in the orthogonal vector magnitude (used as a reference for lead-to-lead comparisons) and to construct a three-dimensional T wave loop. The loop roundness was expressed by a ratio between its circumference and length. These ratios were significantly related to the standard deviation of Tpe durations in different ECG leads. At the underlying heart rate of 60 beats per minute, Tpe intervals were shorter in female than in male individuals (82.5 ± 5.6 vs 90.0 ± 6.5 ms, p < 0.0001). When studying linear slopes between Tpe intervals measured in different leads and the underlying heart rate, we found only minimal heart rate dependency, which was not systematic across the ECG leads and/or across the population. For any ECG lead, positive Tpe/RR slope was found in some subjects (e.g., 79 and 25% of subjects for V2 and V4 measurements, respectively) and a negative Tpe/RR slope in other subjects (e.g., 40 and 65% for V6 and V5, respectively). The steepest positive and negative Tpe/RR slopes were found for measurements in lead V2 and V4, respectively. In all leads, the Tpe/RR slope values were close to zero, indicating, on average, Tpe changes well below 2 ms for RR interval changes of 100 ms. On average, longest Tpe intervals were measured in lead V2, the shortest in lead III. The study concludes that the Tpe intervals measured in different leads cannot be combined. Irrespective of the measured ECG lead, the Tpe interval is not systematically heart rate dependent, and no heart rate correction should be used in clinical Tpe investigations.
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spelling pubmed-77698262020-12-30 Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals Andršová, Irena Hnatkova, Katerina Šišáková, Martina Toman, Ondřej Smetana, Peter Huster, Katharina M. Barthel, Petra Novotný, Tomáš Schmidt, Georg Malik, Marek Front Physiol Physiology The electrocardiographic (ECG) assessment of the T peak–T end (Tpe) intervals has been used in many clinical studies, but several related physiological aspects have not been reported. Specifically, the sources of the Tpe differences between different ECG leads have not been systematically researched, the relationship of Tpe duration to underlying heart rate has not been firmly established, and little is known about the mutual correspondence of Tpe intervals measured in different ECG leads. This study evaluated 796,620 10-s 12-lead ECGs obtained from long-term Holters recorded in 639 healthy subjects (311 female) aged 33.8 ± 9.4 years. For each ECG, transformation to orthogonal XYZ lead was used to measure Tpe in the orthogonal vector magnitude (used as a reference for lead-to-lead comparisons) and to construct a three-dimensional T wave loop. The loop roundness was expressed by a ratio between its circumference and length. These ratios were significantly related to the standard deviation of Tpe durations in different ECG leads. At the underlying heart rate of 60 beats per minute, Tpe intervals were shorter in female than in male individuals (82.5 ± 5.6 vs 90.0 ± 6.5 ms, p < 0.0001). When studying linear slopes between Tpe intervals measured in different leads and the underlying heart rate, we found only minimal heart rate dependency, which was not systematic across the ECG leads and/or across the population. For any ECG lead, positive Tpe/RR slope was found in some subjects (e.g., 79 and 25% of subjects for V2 and V4 measurements, respectively) and a negative Tpe/RR slope in other subjects (e.g., 40 and 65% for V6 and V5, respectively). The steepest positive and negative Tpe/RR slopes were found for measurements in lead V2 and V4, respectively. In all leads, the Tpe/RR slope values were close to zero, indicating, on average, Tpe changes well below 2 ms for RR interval changes of 100 ms. On average, longest Tpe intervals were measured in lead V2, the shortest in lead III. The study concludes that the Tpe intervals measured in different leads cannot be combined. Irrespective of the measured ECG lead, the Tpe interval is not systematically heart rate dependent, and no heart rate correction should be used in clinical Tpe investigations. Frontiers Media S.A. 2020-12-15 /pmc/articles/PMC7769826/ /pubmed/33384609 http://dx.doi.org/10.3389/fphys.2020.595815 Text en Copyright © 2020 Andršová, Hnatkova, Šišáková, Toman, Smetana, Huster, Barthel, Novotný, Schmidt and Malik. http://creativecommons.org/licenses/by/4.0/ 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.
spellingShingle Physiology
Andršová, Irena
Hnatkova, Katerina
Šišáková, Martina
Toman, Ondřej
Smetana, Peter
Huster, Katharina M.
Barthel, Petra
Novotný, Tomáš
Schmidt, Georg
Malik, Marek
Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals
title Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals
title_full Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals
title_fullStr Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals
title_full_unstemmed Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals
title_short Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals
title_sort heart rate dependency and inter-lead variability of the t peak – t end intervals
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769826/
https://www.ncbi.nlm.nih.gov/pubmed/33384609
http://dx.doi.org/10.3389/fphys.2020.595815
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