Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics
Abstract We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time ( $$d_{w}$$ d w ) and amplitude ( $$d_a$$ d a ), as well as their non-linear components ( $${d_w^{{\mathrm{NL}}}}$$ d w NL and $${d_a^{\mathrm{NL}}}$$ d a NL ), and the heart rate corr...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2021-02-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-82935-5 |
| _version_ | 1818752020916469760 |
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| author | Flavio Palmieri Pedro Gomis Dina Ferreira José Esteban Ruiz Beatriz Bergasa Alba Martín-Yebra Hassaan A. Bukhari Esther Pueyo Juan Pablo Martínez Julia Ramírez Pablo Laguna |
| author_facet | Flavio Palmieri Pedro Gomis Dina Ferreira José Esteban Ruiz Beatriz Bergasa Alba Martín-Yebra Hassaan A. Bukhari Esther Pueyo Juan Pablo Martínez Julia Ramírez Pablo Laguna |
| author_sort | Flavio Palmieri |
| collection | DOAJ |
| description | Abstract We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time ( $$d_{w}$$ d w ) and amplitude ( $$d_a$$ d a ), as well as their non-linear components ( $${d_w^{{\mathrm{NL}}}}$$ d w NL and $${d_a^{\mathrm{NL}}}$$ d a NL ), and the heart rate corrected counterpart ( $$d_{w,c}$$ d w , c ), to monitor potassium concentration ( $$[K^{+}]$$ [ K + ] ) changes ( $$\Delta [K^+]$$ Δ [ K + ] ) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We compared the performance of the proposed time-warping markers, together with other previously proposed $$[K^{+}]$$ [ K + ] markers, such as T-wave width ( $$T_w$$ T w ) and T-wave slope-to-amplitude ratio ( $$T_{S/A}$$ T S / A ), when computed from standard ECG leads as well as from principal component analysis (PCA)-based leads. 48-hour ECG recordings and a set of hourly-collected blood samples from 29 ESRD-HD patients were acquired. Values of $$d_w$$ d w , $$d_a$$ d a , $${d_w^{\mathrm{NL}}}$$ d w NL , $${d_a^{\mathrm{NL}}}$$ d a NL and $$d_{w,c}$$ d w , c were calculated by comparing the morphology of the mean warped T-waves (MWTWs) derived at each hour along the HD with that from a reference MWTW, measured at the end of the HD. From the same MWTWs $$T_w$$ T w and $$T_{S/A}$$ T S / A were also extracted. Similarly, $$\Delta [K^+]$$ Δ [ K + ] was calculated as the difference between the $$[K^{+}]$$ [ K + ] values at each hour and the $$[K^{+}]$$ [ K + ] reference level at the end of the HD session. We found that $$d_{w}$$ d w and $$d_{w,c}$$ d w , c showed higher correlation coefficients with $$\Delta [K^+]$$ Δ [ K + ] than $$T_{S/A}$$ T S / A —Spearman’s ( $$\rho$$ ρ ) and Pearson’s (r)—and $$T_w$$ T w —Spearman’s ( $$\rho$$ ρ )—in both SL and PCA approaches being the intra-patient median $$\rho \ge 0.82$$ ρ ≥ 0.82 and $$r \ge 0.87$$ r ≥ 0.87 in SL and $$\rho \ge 0.82$$ ρ ≥ 0.82 and $$r \ge 0.89$$ r ≥ 0.89 in PCA respectively. Our findings would point at $$d_{w}$$ d w and $$d_{w,c}$$ d w , c as the most suitable surrogate of $$\Delta [K^+]$$ Δ [ K + ] , suggesting that they could be potentially useful for non-invasive monitoring of ESRD-HD patients in hospital, as well as in ambulatory settings. Therefore, the tracking of T-wave morphology variations by means of time-warping analysis could improve continuous and remote $$[K^{+}]$$ [ K + ] monitoring of ESRD-HD patients and flagging risk of $$[K^{+}]$$ [ K + ] -related cardiovascular events. |
| first_indexed | 2024-12-18T04:44:50Z |
| format | Article |
| id | doaj.art-7b43820c443847efa978b9aad96ccfc0 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-18T04:44:50Z |
| publishDate | 2021-02-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-7b43820c443847efa978b9aad96ccfc02022-12-21T21:20:36ZengNature PortfolioScientific Reports2045-23222021-02-0111111510.1038/s41598-021-82935-5Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamicsFlavio Palmieri0Pedro Gomis1Dina Ferreira2José Esteban Ruiz3Beatriz Bergasa4Alba Martín-Yebra5Hassaan A. Bukhari6Esther Pueyo7Juan Pablo Martínez8Julia Ramírez9Pablo Laguna10Centre de Recerca en Enginyeria Biomèdica, Universitat Politècnica de CatalunyaCentre de Recerca en Enginyeria Biomèdica, Universitat Politècnica de CatalunyaLaboratorios RubióNephrology Department, Hospital Clínico Universitario Lozano BlesaNephrology Department, Hospital Clínico Universitario Lozano BlesaCIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)William Harvey Research Institute, Queen Mary University of LondonCIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)Abstract We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time ( $$d_{w}$$ d w ) and amplitude ( $$d_a$$ d a ), as well as their non-linear components ( $${d_w^{{\mathrm{NL}}}}$$ d w NL and $${d_a^{\mathrm{NL}}}$$ d a NL ), and the heart rate corrected counterpart ( $$d_{w,c}$$ d w , c ), to monitor potassium concentration ( $$[K^{+}]$$ [ K + ] ) changes ( $$\Delta [K^+]$$ Δ [ K + ] ) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We compared the performance of the proposed time-warping markers, together with other previously proposed $$[K^{+}]$$ [ K + ] markers, such as T-wave width ( $$T_w$$ T w ) and T-wave slope-to-amplitude ratio ( $$T_{S/A}$$ T S / A ), when computed from standard ECG leads as well as from principal component analysis (PCA)-based leads. 48-hour ECG recordings and a set of hourly-collected blood samples from 29 ESRD-HD patients were acquired. Values of $$d_w$$ d w , $$d_a$$ d a , $${d_w^{\mathrm{NL}}}$$ d w NL , $${d_a^{\mathrm{NL}}}$$ d a NL and $$d_{w,c}$$ d w , c were calculated by comparing the morphology of the mean warped T-waves (MWTWs) derived at each hour along the HD with that from a reference MWTW, measured at the end of the HD. From the same MWTWs $$T_w$$ T w and $$T_{S/A}$$ T S / A were also extracted. Similarly, $$\Delta [K^+]$$ Δ [ K + ] was calculated as the difference between the $$[K^{+}]$$ [ K + ] values at each hour and the $$[K^{+}]$$ [ K + ] reference level at the end of the HD session. We found that $$d_{w}$$ d w and $$d_{w,c}$$ d w , c showed higher correlation coefficients with $$\Delta [K^+]$$ Δ [ K + ] than $$T_{S/A}$$ T S / A —Spearman’s ( $$\rho$$ ρ ) and Pearson’s (r)—and $$T_w$$ T w —Spearman’s ( $$\rho$$ ρ )—in both SL and PCA approaches being the intra-patient median $$\rho \ge 0.82$$ ρ ≥ 0.82 and $$r \ge 0.87$$ r ≥ 0.87 in SL and $$\rho \ge 0.82$$ ρ ≥ 0.82 and $$r \ge 0.89$$ r ≥ 0.89 in PCA respectively. Our findings would point at $$d_{w}$$ d w and $$d_{w,c}$$ d w , c as the most suitable surrogate of $$\Delta [K^+]$$ Δ [ K + ] , suggesting that they could be potentially useful for non-invasive monitoring of ESRD-HD patients in hospital, as well as in ambulatory settings. Therefore, the tracking of T-wave morphology variations by means of time-warping analysis could improve continuous and remote $$[K^{+}]$$ [ K + ] monitoring of ESRD-HD patients and flagging risk of $$[K^{+}]$$ [ K + ] -related cardiovascular events.https://doi.org/10.1038/s41598-021-82935-5 |
| spellingShingle | Flavio Palmieri Pedro Gomis Dina Ferreira José Esteban Ruiz Beatriz Bergasa Alba Martín-Yebra Hassaan A. Bukhari Esther Pueyo Juan Pablo Martínez Julia Ramírez Pablo Laguna Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics Scientific Reports |
| title | Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics |
| title_full | Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics |
| title_fullStr | Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics |
| title_full_unstemmed | Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics |
| title_short | Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics |
| title_sort | monitoring blood potassium concentration in hemodialysis patients by quantifying t wave morphology dynamics |
| url | https://doi.org/10.1038/s41598-021-82935-5 |
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