Key result
Time-warping-based ECG markers of T-wave morphology (dw and dw,c) strongly correlated with blood potassium changes (median ρ ≥ 0.82) in end-stage renal disease patients undergoing hemodialysis.
Why the study?
The study investigated whether time-warping-based ECG-derived markers of T-wave morphology dynamics could reliably monitor blood potassium concentration changes in end-stage renal disease patients undergoing hemodialysis.
Does time-warping analysis of T-wave morphology accurately monitor blood potassium concentration changes in ESRD patients undergoing hemodialysis?
Observational (n=29)
No
Does time-warping analysis of T-wave morphology accurately monitor blood potassium concentration changes in ESRD patients undergoing hemodialysis?
Time-warping analysis of T-wave morphology provides a promising non-invasive surrogate for monitoring blood potassium concentration changes in hemodialysis patients.
May support non-invasive potassium monitoring via ECG in hemodialysis; leaves open prospective validation before practice change.
We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time ([Formula: see text]) and amplitude ([Formula: see text]), as well as their non-linear components ([Formula: see text] and [Formula: see text]), and the heart rate corrected counterpart ([Formula: see text]), to monitor potassium concentration ([Formula: see text]) changes ([Formula: see text]) 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 [Formula: see text] markers, such as T-wave width ([Formula: see text]) and T-wave slope-to-amplitude ratio ([Formula: see text]), 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 [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] 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 [Formula: see text] and [Formula: see text] were also extracted. Similarly, [Formula: see text] was calculated as the difference between the [Formula: see text] values at each hour and the [Formula: see text] reference level at the end of the HD session. We found that [Formula: see text] and [Formula: see text] showed higher correlation coefficients with [Formula: see text] than [Formula: see text]-Spearman's ([Formula: see text]) and Pearson's (r)-and [Formula: see text]-Spearman's ([Formula: see text])-in both SL and PCA approaches being the intra-patient median [Formula: see text] and [Formula: see text] in SL and [Formula: see text] and [Formula: see text] in PCA respectively. Our findings would point at [Formula: see text] and [Formula: see text] as the most suitable surrogate of [Formula: see text], 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 [Formula: see text] monitoring of ESRD-HD patients and flagging risk of [Formula: see text]-related cardiovascular events.
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Palmieri et al. (2021) conducted an observational in End-stage renal disease (ESRD) undergoing hemodialysis (n=29). Time-warping-based ECG-derived markers of T-wave morphology (dw, dw,c) vs. T-wave width (Tw) and T-wave slope-to-amplitude ratio (TS/A) was evaluated on Intra-patient correlation between blood potassium concentration changes and ECG markers (Spearman's ρ ≥ 0.82). Time-warping-based ECG markers of T-wave morphology (dw and dw,c) strongly correlated with blood potassium changes (median ρ ≥ 0.82) in end-stage renal disease patients undergoing hemodialysis.
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