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Differences in ventricular wall composition may explain inter-patient variability in the ECG response to variations in serum potassium and calcium.
Bukhari, Hassaan A; Sánchez, Carlos; Laguna, Pablo; Potse, Mark; Pueyo, Esther.
Afiliação
  • Bukhari HA; BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain.
  • Sánchez C; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain.
  • Laguna P; Carmen Team, Inria Bordeaux-Sud-Ouest, Talence, France.
  • Potse M; University of Bordeaux, IMB, UMR 5251, Talence, France.
  • Pueyo E; BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain.
Front Physiol ; 14: 1060919, 2023.
Article em En | MEDLINE | ID: mdl-37885805
ABSTRACT

Objective:

Chronic kidney disease patients have a decreased ability to maintain normal electrolyte concentrations in their blood, which increases the risk for ventricular arrhythmias and sudden cardiac death. Non-invasive monitoring of serum potassium and calcium concentration, [K+] and [Ca2+], can help to prevent arrhythmias in these patients. Electrocardiogram (ECG) markers that significantly correlate with [K+] and [Ca2+] have been proposed, but these relations are highly variable between patients. We hypothesized that inter-individual differences in cell type distribution across the ventricular wall can help to explain this variability.

Methods:

A population of human heart-torso models were built with different proportions of endocardial, midmyocardial and epicardial cells. Propagation of ventricular electrical activity was described by a reaction-diffusion model, with modified Ten Tusscher-Panfilov dynamics. [K+] and [Ca2+] were varied individually and in combination. Twelve-lead ECGs were simulated and the width, amplitude and morphological variability of T waves and QRS complexes were quantified. Results were compared to measurements from 29 end-stage renal disease (ESRD) patients undergoing hemodialysis (HD).

Results:

Both simulations and patients data showed that most of the analyzed T wave and QRS complex markers correlated strongly with [K+] (absolute median Pearson correlation coefficients, r, ranging from 0.68 to 0.98) and [Ca2+] (ranging from 0.70 to 0.98). The same sign and similar magnitude of median r was observed in the simulations and the patients. Different cell type distributions in the ventricular wall led to variability in ECG markers that was accentuated at high [K+] and low [Ca2+], in agreement with the larger variability between patients measured at the onset of HD. The simulated ECG variability explained part of the measured inter-patient variability.

Conclusion:

Changes in ECG markers were similarly related to [K+] and [Ca2+] variations in our models and in the ESRD patients. The high inter-patient ECG variability may be explained by variations in cell type distribution across the ventricular wall, with high sensitivity to variations in the proportion of epicardial cells.

Significance:

Differences in ventricular wall composition help to explain inter-patient variability in ECG response to [K+] and [Ca2+]. This finding can be used to improve serum electrolyte monitoring in ESRD patients.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2023 Tipo de documento: Article