Noninvasive potassium determination using a mathematically processed ECG: Proof of concept for a novel "blood-less, blood test"

John J. Dillon, Christopher V. Desimone, Yehu Sapir, Virend Somers, Jennifer L. Dugan, Charles J Bruce, Michael John Ackerman, Samuel J Asirvatham, Bryan L. Striemer, Jan Bukartyk, Christopher G. Scott, Kevin E. Bennet, Susan B. Mikell, Dorothy J. Ladewig, Emily J. Gilles, Amir Geva, Dan Sadot, Paul Andrew Friedman

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective To determine if ECG repolarization measures can be used to detect small changes in serum potassium levels in hemodialysis patients. Patients and Methods Signal-averaged ECGs were obtained from standard ECG leads in 12 patients before, during, and after dialysis. Based on physiological considerations, five repolarization-related ECG measures were chosen and automatically extracted for analysis: the slope of the T wave downstroke (T right slope), the amplitude of the T wave (T amplitude), the center of gravity (COG) of the T wave (T COG), the ratio of the amplitude of the T wave to amplitude of the R wave (T/R amplitude), and the center of gravity of the last 25% of the area under the T wave curve (T4 COG) (Fig. 1). Results The correlations with potassium were statistically significant for T right slope (P < 0.0001), T COG (P = 0.007), T amplitude (P = 0.0006) and T/R amplitude (P = 0.03), but not T4 COG (P = 0.13). Potassium changes as small as 0.2 mmol/L were detectable. Conclusion Small changes in blood potassium concentrations, within the normal range, resulted in quantifiable changes in the processed, signal-averaged ECG. This indicates that non-invasive, ECG-based potassium measurement is feasible and suggests that continuous or remote monitoring systems could be developed to detect early potassium deviations among high-risk patients, such as those with cardiovascular and renal diseases. The results of this feasibility study will need to be further confirmed in a larger cohort of patients.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalJournal of Electrocardiology
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2015

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Gravitation
Hematologic Tests
Potassium
Electrocardiography
Feasibility Studies
Renal Dialysis
Dialysis
Reference Values
Cardiovascular Diseases
Kidney
Serum

Keywords

  • Dialysis
  • ECG
  • Hyperkalemia
  • Potassium
  • Signal processing
  • T-wave

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Noninvasive potassium determination using a mathematically processed ECG : Proof of concept for a novel "blood-less, blood test". / Dillon, John J.; Desimone, Christopher V.; Sapir, Yehu; Somers, Virend; Dugan, Jennifer L.; Bruce, Charles J; Ackerman, Michael John; Asirvatham, Samuel J; Striemer, Bryan L.; Bukartyk, Jan; Scott, Christopher G.; Bennet, Kevin E.; Mikell, Susan B.; Ladewig, Dorothy J.; Gilles, Emily J.; Geva, Amir; Sadot, Dan; Friedman, Paul Andrew.

In: Journal of Electrocardiology, Vol. 48, No. 1, 01.01.2015, p. 12-18.

Research output: Contribution to journalArticle

Dillon, JJ, Desimone, CV, Sapir, Y, Somers, V, Dugan, JL, Bruce, CJ, Ackerman, MJ, Asirvatham, SJ, Striemer, BL, Bukartyk, J, Scott, CG, Bennet, KE, Mikell, SB, Ladewig, DJ, Gilles, EJ, Geva, A, Sadot, D & Friedman, PA 2015, 'Noninvasive potassium determination using a mathematically processed ECG: Proof of concept for a novel "blood-less, blood test"', Journal of Electrocardiology, vol. 48, no. 1, pp. 12-18. https://doi.org/10.1016/j.jelectrocard.2014.10.002
Dillon, John J. ; Desimone, Christopher V. ; Sapir, Yehu ; Somers, Virend ; Dugan, Jennifer L. ; Bruce, Charles J ; Ackerman, Michael John ; Asirvatham, Samuel J ; Striemer, Bryan L. ; Bukartyk, Jan ; Scott, Christopher G. ; Bennet, Kevin E. ; Mikell, Susan B. ; Ladewig, Dorothy J. ; Gilles, Emily J. ; Geva, Amir ; Sadot, Dan ; Friedman, Paul Andrew. / Noninvasive potassium determination using a mathematically processed ECG : Proof of concept for a novel "blood-less, blood test". In: Journal of Electrocardiology. 2015 ; Vol. 48, No. 1. pp. 12-18.
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abstract = "Objective To determine if ECG repolarization measures can be used to detect small changes in serum potassium levels in hemodialysis patients. Patients and Methods Signal-averaged ECGs were obtained from standard ECG leads in 12 patients before, during, and after dialysis. Based on physiological considerations, five repolarization-related ECG measures were chosen and automatically extracted for analysis: the slope of the T wave downstroke (T right slope), the amplitude of the T wave (T amplitude), the center of gravity (COG) of the T wave (T COG), the ratio of the amplitude of the T wave to amplitude of the R wave (T/R amplitude), and the center of gravity of the last 25{\%} of the area under the T wave curve (T4 COG) (Fig. 1). Results The correlations with potassium were statistically significant for T right slope (P < 0.0001), T COG (P = 0.007), T amplitude (P = 0.0006) and T/R amplitude (P = 0.03), but not T4 COG (P = 0.13). Potassium changes as small as 0.2 mmol/L were detectable. Conclusion Small changes in blood potassium concentrations, within the normal range, resulted in quantifiable changes in the processed, signal-averaged ECG. This indicates that non-invasive, ECG-based potassium measurement is feasible and suggests that continuous or remote monitoring systems could be developed to detect early potassium deviations among high-risk patients, such as those with cardiovascular and renal diseases. The results of this feasibility study will need to be further confirmed in a larger cohort of patients.",
keywords = "Dialysis, ECG, Hyperkalemia, Potassium, Signal processing, T-wave",
author = "Dillon, {John J.} and Desimone, {Christopher V.} and Yehu Sapir and Virend Somers and Dugan, {Jennifer L.} and Bruce, {Charles J} and Ackerman, {Michael John} and Asirvatham, {Samuel J} and Striemer, {Bryan L.} and Jan Bukartyk and Scott, {Christopher G.} and Bennet, {Kevin E.} and Mikell, {Susan B.} and Ladewig, {Dorothy J.} and Gilles, {Emily J.} and Amir Geva and Dan Sadot and Friedman, {Paul Andrew}",
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T1 - Noninvasive potassium determination using a mathematically processed ECG

T2 - Proof of concept for a novel "blood-less, blood test"

AU - Dillon, John J.

AU - Desimone, Christopher V.

AU - Sapir, Yehu

AU - Somers, Virend

AU - Dugan, Jennifer L.

AU - Bruce, Charles J

AU - Ackerman, Michael John

AU - Asirvatham, Samuel J

AU - Striemer, Bryan L.

AU - Bukartyk, Jan

AU - Scott, Christopher G.

AU - Bennet, Kevin E.

AU - Mikell, Susan B.

AU - Ladewig, Dorothy J.

AU - Gilles, Emily J.

AU - Geva, Amir

AU - Sadot, Dan

AU - Friedman, Paul Andrew

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objective To determine if ECG repolarization measures can be used to detect small changes in serum potassium levels in hemodialysis patients. Patients and Methods Signal-averaged ECGs were obtained from standard ECG leads in 12 patients before, during, and after dialysis. Based on physiological considerations, five repolarization-related ECG measures were chosen and automatically extracted for analysis: the slope of the T wave downstroke (T right slope), the amplitude of the T wave (T amplitude), the center of gravity (COG) of the T wave (T COG), the ratio of the amplitude of the T wave to amplitude of the R wave (T/R amplitude), and the center of gravity of the last 25% of the area under the T wave curve (T4 COG) (Fig. 1). Results The correlations with potassium were statistically significant for T right slope (P < 0.0001), T COG (P = 0.007), T amplitude (P = 0.0006) and T/R amplitude (P = 0.03), but not T4 COG (P = 0.13). Potassium changes as small as 0.2 mmol/L were detectable. Conclusion Small changes in blood potassium concentrations, within the normal range, resulted in quantifiable changes in the processed, signal-averaged ECG. This indicates that non-invasive, ECG-based potassium measurement is feasible and suggests that continuous or remote monitoring systems could be developed to detect early potassium deviations among high-risk patients, such as those with cardiovascular and renal diseases. The results of this feasibility study will need to be further confirmed in a larger cohort of patients.

AB - Objective To determine if ECG repolarization measures can be used to detect small changes in serum potassium levels in hemodialysis patients. Patients and Methods Signal-averaged ECGs were obtained from standard ECG leads in 12 patients before, during, and after dialysis. Based on physiological considerations, five repolarization-related ECG measures were chosen and automatically extracted for analysis: the slope of the T wave downstroke (T right slope), the amplitude of the T wave (T amplitude), the center of gravity (COG) of the T wave (T COG), the ratio of the amplitude of the T wave to amplitude of the R wave (T/R amplitude), and the center of gravity of the last 25% of the area under the T wave curve (T4 COG) (Fig. 1). Results The correlations with potassium were statistically significant for T right slope (P < 0.0001), T COG (P = 0.007), T amplitude (P = 0.0006) and T/R amplitude (P = 0.03), but not T4 COG (P = 0.13). Potassium changes as small as 0.2 mmol/L were detectable. Conclusion Small changes in blood potassium concentrations, within the normal range, resulted in quantifiable changes in the processed, signal-averaged ECG. This indicates that non-invasive, ECG-based potassium measurement is feasible and suggests that continuous or remote monitoring systems could be developed to detect early potassium deviations among high-risk patients, such as those with cardiovascular and renal diseases. The results of this feasibility study will need to be further confirmed in a larger cohort of patients.

KW - Dialysis

KW - ECG

KW - Hyperkalemia

KW - Potassium

KW - Signal processing

KW - T-wave

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