T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization.
<h4>Background</h4>We present a new family of ECG biomarkers for assessing drug effects on ventricular repolarization. We show that drugs blocking inward (depolarizing) ion currents cause a relative increase of the T vector velocity (TVV) and accelerate repolarization, while drugs blocki...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0204712 |
| _version_ | 1819140227596288000 |
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| author | Werner Bystricky Christoph Maier Gary Gintant Dennis Bergau Kent Kamradt Patrick Welsh David Carter |
| author_facet | Werner Bystricky Christoph Maier Gary Gintant Dennis Bergau Kent Kamradt Patrick Welsh David Carter |
| author_sort | Werner Bystricky |
| collection | DOAJ |
| description | <h4>Background</h4>We present a new family of ECG biomarkers for assessing drug effects on ventricular repolarization. We show that drugs blocking inward (depolarizing) ion currents cause a relative increase of the T vector velocity (TVV) and accelerate repolarization, while drugs blocking outward ion currents cause a relative decrease of the TVV and delay repolarization. The results suggest a link between the TVV and the instantaneous change of the cellular action potentials that may contribute to bridge the gap between the surface ECG and myocardial cellular processes.<h4>Methods</h4>We measure TVV as the time required to reach X% of the total Trajectory length of the T vector loop, denoted as TrX. Applied to data from two FDA funded studies (22+22 subjects, 5232+4208 ECGs) which target ECG effects of various ion-channel blocking drugs, the TrX effect profiles indicate increasingly delayed electrical activity over the entire repolarization process for drugs solely reducing outward potassium current (dofetilide, moxifloxacin). For drugs eliciting block of the inward sodium or calcium currents (mexiletine, lidocaine), the TrX effect profiles were consistent with accelerated electrical activity in the initial repolarization phase. For multichannel blocking drugs (ranolazine) or drug combinations blocking multiple ion currents (dofetilide + mexiletine, dofetilide + lidocaine), the overall TrX effect profiles indicate a superposition of the individual TrX effect profiles.<h4>Results</h4>The parameter Tr40c differentiates pure potassium channel blocking drugs from multichannel blocking drugs with an area under the ROC curve (AUC) of 0.90, CI = [0.88 to 0.92]. This is significantly better than the performance of J-Tpeakc (0.81, CI = [0.78 to 0.84]) identified as the best parameter in the second FDA study. Combining the ten parameters Tr10c to Tr100c in a logistic regression model further improved the AUC to 0.94, CI = [0.92 to 0.96].<h4>Conclusions</h4>TVV analysis substantially improves assessment of drug effects on cardiac repolarization, providing a plausible and improved mechanistic link between drug effects on ionic currents and overall ventricular repolarization reflected in the body surface ECG. TVV contributes to an enhanced appraisal of the proarrhythmic risk of drugs beyond QTc prolongation and J-Tpeakc. |
| first_indexed | 2024-12-22T11:35:12Z |
| format | Article |
| id | doaj.art-11f4a5406d914d2eb5d9f29f26269b9a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T11:35:12Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-11f4a5406d914d2eb5d9f29f26269b9a2022-12-21T18:27:27ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01147e020471210.1371/journal.pone.0204712T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization.Werner BystrickyChristoph MaierGary GintantDennis BergauKent KamradtPatrick WelshDavid Carter<h4>Background</h4>We present a new family of ECG biomarkers for assessing drug effects on ventricular repolarization. We show that drugs blocking inward (depolarizing) ion currents cause a relative increase of the T vector velocity (TVV) and accelerate repolarization, while drugs blocking outward ion currents cause a relative decrease of the TVV and delay repolarization. The results suggest a link between the TVV and the instantaneous change of the cellular action potentials that may contribute to bridge the gap between the surface ECG and myocardial cellular processes.<h4>Methods</h4>We measure TVV as the time required to reach X% of the total Trajectory length of the T vector loop, denoted as TrX. Applied to data from two FDA funded studies (22+22 subjects, 5232+4208 ECGs) which target ECG effects of various ion-channel blocking drugs, the TrX effect profiles indicate increasingly delayed electrical activity over the entire repolarization process for drugs solely reducing outward potassium current (dofetilide, moxifloxacin). For drugs eliciting block of the inward sodium or calcium currents (mexiletine, lidocaine), the TrX effect profiles were consistent with accelerated electrical activity in the initial repolarization phase. For multichannel blocking drugs (ranolazine) or drug combinations blocking multiple ion currents (dofetilide + mexiletine, dofetilide + lidocaine), the overall TrX effect profiles indicate a superposition of the individual TrX effect profiles.<h4>Results</h4>The parameter Tr40c differentiates pure potassium channel blocking drugs from multichannel blocking drugs with an area under the ROC curve (AUC) of 0.90, CI = [0.88 to 0.92]. This is significantly better than the performance of J-Tpeakc (0.81, CI = [0.78 to 0.84]) identified as the best parameter in the second FDA study. Combining the ten parameters Tr10c to Tr100c in a logistic regression model further improved the AUC to 0.94, CI = [0.92 to 0.96].<h4>Conclusions</h4>TVV analysis substantially improves assessment of drug effects on cardiac repolarization, providing a plausible and improved mechanistic link between drug effects on ionic currents and overall ventricular repolarization reflected in the body surface ECG. TVV contributes to an enhanced appraisal of the proarrhythmic risk of drugs beyond QTc prolongation and J-Tpeakc.https://doi.org/10.1371/journal.pone.0204712 |
| spellingShingle | Werner Bystricky Christoph Maier Gary Gintant Dennis Bergau Kent Kamradt Patrick Welsh David Carter T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization. PLoS ONE |
| title | T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization. |
| title_full | T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization. |
| title_fullStr | T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization. |
| title_full_unstemmed | T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization. |
| title_short | T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization. |
| title_sort | t vector velocity a new ecg biomarker for identifying drug effects on cardiac ventricular repolarization |
| url | https://doi.org/10.1371/journal.pone.0204712 |
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