Novel bloodless potassium determination using a signal-processed single-lead ECG

Zachi I. Attia, Christopher V. DeSimone, John J. Dillon, 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, Dorothy J. Ladewig, Emily J. Gilles, Dan Sadot, Amir B. Geva, Paul Andrew Friedman

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background-Hyper- and hypokalemia are clinically silent, common in patients with renal or cardiac disease, and are life threatening. A noninvasive, unobtrusive, blood-free method for tracking potassium would be an important clinical advance. Methods and Results-Two groups of hemodialysis patients (development group, n=26; validation group, n=19) underwent highresolution digital ECG recordings and had 2 to 3 blood tests during dialysis. Using advanced signal processing, we developed a personalized regression model for each patient to noninvasively calculate potassiumvalues during the second and third dialysis sessions using only the processed single-channel ECG. In addition, by analyzing the entire development group's first-visit data,we created a global model for all patients that was validated against subsequent sessions in the development group and in a separate validation group. This global model sought to predict potassium, based on the T wave characteristics, with no blood tests required. For the personalized model, we successfully calculated potassium values with an absolute error of 0.36±0.34 mmol/L (or 10% of the measured blood potassium). For the global model, potassium prediction was also accurate, with an absolute error of 0.44±0.47 mmol/L for the training group (or 11% of the measured blood potassium) and 0.5±0.42 for the validation set (or 12% of the measured blood potassium). Conclusions-The signal-processed ECG derived from a single lead can be used to calculate potassium values with clinically meaningful resolution using a strategy that requires no blood tests. This enables a cost-effective, noninvasive, unobtrusive strategy for potassium assessment that can be used during remote monitoring.

Original languageEnglish (US)
Article numbere002746
JournalJournal of the American Heart Association
Volume5
Issue number1
DOIs
StatePublished - 2016

Keywords

  • Electrophysiology
  • Potassium
  • Waves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Attia, Z. I., DeSimone, C. V., Dillon, J. J., Sapir, Y., Somers, V., Dugan, J. L., Bruce, C. J., Ackerman, M. J., Asirvatham, S. J., Striemer, B. L., Bukartyk, J., Scott, C. G., Bennet, K. E., Ladewig, D. J., Gilles, E. J., Sadot, D., Geva, A. B., & Friedman, P. A. (2016). Novel bloodless potassium determination using a signal-processed single-lead ECG. Journal of the American Heart Association, 5(1), [e002746]. https://doi.org/10.1161/JAHA.115.002746