Novel Biomarker for Evaluating Ischemic Stress Using an Electrogram Derived Phase Space.

The underlying pathophysiology of ischemia is poorly understood, resulting in unreliable clinical diagnosis of this disease. This limited knowledge of underlying mechanisms suggested a data driven approach, which seeks to identify patterns in the ECG data that can be linked statistically to underlying behavior and conditions of ischemic tissue. Previous studies have suggested that an approach known as Laplacian eigenmaps (LE) can identify trajectories, or manifolds, that are sensitive to different spatiotemporal consequences of ischemic stress, and thus serve as potential clinically relevant biomarkers. We applied the LE approach to measured transmural potentials in several canine preparations, recorded during control and ischemic conditions, and discovered regions on an approximated QRS-derived manifold that were sensitive to ischemia. By identifying a vector pointing to ischemia-associated changes to the manifold and measuring the shift in trajectories along that vector during ischemia, which we denote as Mshift, it was possible to also pull that vector back into signal space and determine which electrodes were responsible for driving the observed changes in the manifold. We refer to the signal space change as the manifold differential (Mdiff). Both the Mdiff and Mshift metrics show a similar degree of sensitivity to ischemic changes as standard metrics applied during the ST segment in detecting ischemic regions. The new metrics also were able to distinguish between sub-types of ischemia. Thus our results indicate that it may be possible to use the Mshift and Mdiff metrics along with ST derived metrics to determine whether tissue within the myocardium is ischemic or not.