Observational studyJournal of electrocardiology
Evaluation of beat-to-beat ventricular repolarization lability from standard 12-lead ECG during acute myocardial ischemia.
Observational study in Journal of electrocardiology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 12 citations in OpenAlex.
- Review
- Diagnostic accuracy of wearable ECG and assessment of ventricular repolarization and its cardiovascular risks post cold stress.Scientific reports · 2025Article
- Regional beat-to-beat variability of repolarization increases during ischemia and predicts imminent arrhythmias in a pig model of myocardial infarction.American journal of physiology. Heart and circulatory physiology · 2023Article
- Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction.Nature medicine · 2023Observational
- Machine Learning for the ECG Diagnosis and Risk Stratification of Occlusion Myocardial Infarction at First Medical Contact.Research square · 2023Article
- In Search of an Optimal Subset of ECG Features to Augment the Diagnosis of Acute Coronary Syndrome at the Emergency Department.Journal of the American Heart Association · 2021Observational
- Machine learning-based prediction of acute coronary syndrome using only the pre-hospital 12-lead electrocardiogram.Nature communications · 2020Article
- Comparison of clinical risk scores for triaging high-risk chest pain patients at the emergency department.The American journal of emergency medicine · 2019Article
- Emerging ECG methods for acute coronary syndrome detection: Recommendations & future opportunities.Journal of electrocardiologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAcute myocardial ischemia is a common cause of ventricular arrhythmias, yet recent ECG methods predicting susceptibility to ventricular tachyarrhythmia have not been fully evaluated during spontaneous ischemia. We sought to evaluate the clinical utility of alternans and non-alternans components of repolarization variability from the standard 10-second 12-lead ECG signals to risk stratify patients with acute chest pain.
methodsWe enrolled consecutive, non-traumatic, chest pain patients transported through Emergency Medical Services (EMS) to three tertiary care hospitals with cardiac catheterization lab capabilities in Pittsburgh, PA. ECG signals were manually annotated by an electrophysiologist, then automatically processed using a custom-written software. Both T wave alternans (TWA) and non-alternans repolarization variability (NARV) were calculated using the absolute RMS differences over the repolarization window between odd/even averaged beats and between consecutive averaged pairs, respectively. The primary study outcome was the presence of acute myocardial infarction (AMI) documented by cardiac angiography.
resultsAfter excluding patients with secondary repolarization changes (n=123) and those with excessive noise (n=90), our final sample included 537 patients (age 57±16years, 56% males). Patients with AMI (n=47, 9%) had higher TWA and NARV values (p<0.01). Mean RR correlated with TWA, and noise measures correlated with TWA and NARV, after adjusting for potential confounders. There was a high collinearity between TWA and NARV, and each was separately predictive of AMI after controlling for number of analyzed beats, noise measures, and other clinical variables.
conclusionsDespite limitations imposed by signal quality, TWA and NARV are higher in patients with AMI, even after correction for potential confounders. The clinical value of TWA and NARV derived from standard ECG using our time-domain RMS method is questionable due to the small number of beats and significant noise.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.