Reproducibility of global electrical heterogeneity measurements on 12-lead ECG: The Multi-Ethnic Study of Atherosclerosis

Objective Vectorcardiographic (VCG) global electrical heterogeneity (GEH) metrics showed clinical usefulness. We aimed to assess the reproducibility of GEH metrics. Methods GEH was measured on two 10-second 12-lead ECGs recorded on the same day in 4,316 participants of the Multi-Ethnic Study of Atherosclerosis (age 69.4±9.4 y; 2317(54%) female, 1728 (40%) white, 1138(26%) African-American, 519(12%) Asian-American, 931(22%) Hispanic-American). GEH was measured on a median beat, comprised of the normal sinus (N), atrial fibrillation/flutter (S), and ventricular-paced (VP) beats. Spatial ventricular gradient’s (SVG’s) scalar was measured as sum absolute QRST integral (SAIQRST) and vector magnitude QT integral (VMQTi). Results Two N ECGs with heart rate (HR) bias of -0.64 (95% limits of agreement [LOA] - 5.68 to 5.21) showed spatial area QRS-T angle (aQRST) bias of -0.12 (95%LOA -14.8 to 14.5). Two S ECGs with HR bias of 0.20 (95%LOA -15.8 to 16.2) showed aQRST bias of 1.37 (95%LOA -33.2 to 35.9). Two VP ECGs with HR bias of 0.25 (95%LOA -3.0 to 3.5) showed aQRST bias of -1.03 (95%LOA -11.9 to 9.9). After excluding premature arial or ventricular beat and two additional beats (before and after extrasystole), the number of cardiac beats included in a median beat did not affect the GEH reproducibility. Mean-centered log-transformed values of SAIQRST and VMQTi demonstrated perfect agreement (Bias 0; 95%LOA -0.092 to 0.092). Conclusion GEH measurements on N, S, and VP median beats are reproducible. SVG’s scalar can be measured as either SAIQRST or VMQTi. Significance Satisfactory reproducibility of GEH metrics supports their implementation. Highlights VCG metrics are reliably reproducible, which supports their implementation. GEH is reproducible if measured during atrial fibrillation or ventricular pacing. Scalar of spatial ventricular gradient can be measured as either SAIQRST or VMQTi.