A spatio-temporal study of ischemia and the time-frequency coupling variations between the ST amplitude, heart rate and dominant angle

An analysis of the Long Term ST Database (LTSTDB) was conducted to quantify the spatio-temporal dynamics of ischemic and non-ischemic episodes. For all 86 recordings the ischemic episode length is decribed by a lognormal distribution and the non-ischemic episode length by a generalized extreme value distribution. For the 15 recordings that possess orthogonal (EASI) leads sets we derived the 12 standard leads and analyzed the spatial time course (from the j-point to j+120 ms) of each episode over time to identify dominant trends. Although the magnitude of the ischemic episodes did not reveal any inter-subject trend (except for generally exhibiting Brownian-like motion), there appeared to be strong correlations with the heart rate (HR). Wavelet cross-spectral coupling with significance testing was then applied to the ST-amplitude and HR evolution over the course of each episode. In all subjects significant cross-spectral correlations were found at very low frequencies (<0.04 Hz), as well as at respiration and baroreflex frequencies. This may indicate that the ischemic episodes are modulated by blood pressure and activity or HR-related phenomena and that all episodes in the LTSTDB may be of a ‘mixed’ type at some point in their duration. The dominant angle also showed significant correlation (p<0.01) with the ST amplitude and HR changes at similar frequencies to those described above. All three protocols used to define ischemia in the LTSTDB gave similar results.