Manual vs. automatic assessment of the QT-interval and corrected QT

Benjamin Neumann; A.S. Vink; Ben J M Hermans; Krystien V V Lieve; Didem Cömert; Britt-Maria Beckmann; Sally-Ann B Clur; Nico A Blom; Tammo Delhaas; Arthur A M Wilde; Stefan Kääb; Pieter G Postema; Moritz F Sinner

doi:https://doi.org/10.1093/europace/euad213

Manual vs. automatic assessment of the QT-interval and corrected QT

Benjamin Neumann, A.S. Vink, Ben J M Hermans, Krystien V V Lieve, Didem Cömert, Britt-Maria Beckmann, Sally-Ann B Clur, Nico A Blom, Tammo Delhaas, Arthur A M Wilde, Stefan Kääb, Pieter G Postema, Moritz F Sinner

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

AIMS: Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG)-derived heart rate-corrected QT-interval (QTc) is used for SCD-risk assessment. QTc is preferably determined manually, but vendor-provided automatic results from ECG recorders are convenient. Agreement between manual and automatic assessments is unclear for populations with aberrant QTc. We aimed to systematically assess pairwise agreement of automatic and manual QT-intervals and QTc.

METHODS AND RESULTS: A multi-centre cohort enriching aberrant QTc comprised ECGs of healthy controls and long-QT syndrome (LQTS) patients. Manual QT-intervals and QTc were determined by the tangent and threshold methods and compared to automatically generated, vendor-provided values. We assessed agreement globally by intra-class correlation coefficients and pairwise by Bland-Altman analyses and 95% limits of agreement (LoA). Further, manual results were compared to a novel automatic QT-interval algorithm. ECGs of 1263 participants (720 LQTS patients; 543 controls) were available [median age 34 (inter-quartile range 35) years, 55% women]. Comparing cohort means, automatic and manual QT-intervals and QTc were similar. However, pairwise Bland-Altman-based agreement was highly discrepant. For QT-interval, LoAs spanned 95 (tangent) and 92 ms (threshold), respectively. For QTc, the spread was 108 and 105 ms, respectively. LQTS patients exhibited more pronounced differences. For automatic QTc results from 440-540 ms (tangent) and 430-530 ms (threshold), misassessment risk was highest. Novel automatic QT-interval algorithms may narrow this range.

CONCLUSION: Pairwise vendor-provided automatic and manual QT-interval and QTc results can be highly discrepant. Novel automatic algorithms may improve agreement. Within the above ranges, automatic QT-interval and QTc results require manual confirmation, particularly if T-wave morphology is challenging.

Original language	English
Journal	EP Europace
Volume	25
Issue number	9
DOIs	https://doi.org/10.1093/europace/euad213
Publication status	Published - 2 Aug 2023

Keywords

Humans
Female
Adult
Male
Electrocardiography
Long QT Syndrome/diagnosis
Death, Sudden, Cardiac/etiology
Arrhythmias, Cardiac
Risk Assessment

Access to Document

https://doi.org/10.1093/europace/euad213

Cite this

@article{d0f47ff1698f425aa22912af66470250,

title = "Manual vs. automatic assessment of the QT-interval and corrected QT",

abstract = "AIMS: Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG)-derived heart rate-corrected QT-interval (QTc) is used for SCD-risk assessment. QTc is preferably determined manually, but vendor-provided automatic results from ECG recorders are convenient. Agreement between manual and automatic assessments is unclear for populations with aberrant QTc. We aimed to systematically assess pairwise agreement of automatic and manual QT-intervals and QTc.METHODS AND RESULTS: A multi-centre cohort enriching aberrant QTc comprised ECGs of healthy controls and long-QT syndrome (LQTS) patients. Manual QT-intervals and QTc were determined by the tangent and threshold methods and compared to automatically generated, vendor-provided values. We assessed agreement globally by intra-class correlation coefficients and pairwise by Bland-Altman analyses and 95% limits of agreement (LoA). Further, manual results were compared to a novel automatic QT-interval algorithm. ECGs of 1263 participants (720 LQTS patients; 543 controls) were available [median age 34 (inter-quartile range 35) years, 55% women]. Comparing cohort means, automatic and manual QT-intervals and QTc were similar. However, pairwise Bland-Altman-based agreement was highly discrepant. For QT-interval, LoAs spanned 95 (tangent) and 92 ms (threshold), respectively. For QTc, the spread was 108 and 105 ms, respectively. LQTS patients exhibited more pronounced differences. For automatic QTc results from 440-540 ms (tangent) and 430-530 ms (threshold), misassessment risk was highest. Novel automatic QT-interval algorithms may narrow this range.CONCLUSION: Pairwise vendor-provided automatic and manual QT-interval and QTc results can be highly discrepant. Novel automatic algorithms may improve agreement. Within the above ranges, automatic QT-interval and QTc results require manual confirmation, particularly if T-wave morphology is challenging.",

keywords = "Humans, Female, Adult, Male, Electrocardiography, Long QT Syndrome/diagnosis, Death, Sudden, Cardiac/etiology, Arrhythmias, Cardiac, Risk Assessment",

author = "Benjamin Neumann and A.S. Vink and Hermans, {Ben J M} and Lieve, {Krystien V V} and Didem C{\"o}mert and Britt-Maria Beckmann and Clur, {Sally-Ann B} and Blom, {Nico A} and Tammo Delhaas and Wilde, {Arthur A M} and Stefan K{\"a}{\"a}b and Postema, {Pieter G} and Sinner, {Moritz F}",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = aug,

day = "2",

doi = "https://doi.org/10.1093/europace/euad213",

language = "English",

volume = "25",

journal = "EP Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "9",

}

TY - JOUR

T1 - Manual vs. automatic assessment of the QT-interval and corrected QT

AU - Neumann, Benjamin

AU - Vink, A.S.

AU - Hermans, Ben J M

AU - Lieve, Krystien V V

AU - Cömert, Didem

AU - Beckmann, Britt-Maria

AU - Clur, Sally-Ann B

AU - Blom, Nico A

AU - Delhaas, Tammo

AU - Wilde, Arthur A M

AU - Kääb, Stefan

AU - Postema, Pieter G

AU - Sinner, Moritz F

N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/8/2

Y1 - 2023/8/2

N2 - AIMS: Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG)-derived heart rate-corrected QT-interval (QTc) is used for SCD-risk assessment. QTc is preferably determined manually, but vendor-provided automatic results from ECG recorders are convenient. Agreement between manual and automatic assessments is unclear for populations with aberrant QTc. We aimed to systematically assess pairwise agreement of automatic and manual QT-intervals and QTc.METHODS AND RESULTS: A multi-centre cohort enriching aberrant QTc comprised ECGs of healthy controls and long-QT syndrome (LQTS) patients. Manual QT-intervals and QTc were determined by the tangent and threshold methods and compared to automatically generated, vendor-provided values. We assessed agreement globally by intra-class correlation coefficients and pairwise by Bland-Altman analyses and 95% limits of agreement (LoA). Further, manual results were compared to a novel automatic QT-interval algorithm. ECGs of 1263 participants (720 LQTS patients; 543 controls) were available [median age 34 (inter-quartile range 35) years, 55% women]. Comparing cohort means, automatic and manual QT-intervals and QTc were similar. However, pairwise Bland-Altman-based agreement was highly discrepant. For QT-interval, LoAs spanned 95 (tangent) and 92 ms (threshold), respectively. For QTc, the spread was 108 and 105 ms, respectively. LQTS patients exhibited more pronounced differences. For automatic QTc results from 440-540 ms (tangent) and 430-530 ms (threshold), misassessment risk was highest. Novel automatic QT-interval algorithms may narrow this range.CONCLUSION: Pairwise vendor-provided automatic and manual QT-interval and QTc results can be highly discrepant. Novel automatic algorithms may improve agreement. Within the above ranges, automatic QT-interval and QTc results require manual confirmation, particularly if T-wave morphology is challenging.

AB - AIMS: Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG)-derived heart rate-corrected QT-interval (QTc) is used for SCD-risk assessment. QTc is preferably determined manually, but vendor-provided automatic results from ECG recorders are convenient. Agreement between manual and automatic assessments is unclear for populations with aberrant QTc. We aimed to systematically assess pairwise agreement of automatic and manual QT-intervals and QTc.METHODS AND RESULTS: A multi-centre cohort enriching aberrant QTc comprised ECGs of healthy controls and long-QT syndrome (LQTS) patients. Manual QT-intervals and QTc were determined by the tangent and threshold methods and compared to automatically generated, vendor-provided values. We assessed agreement globally by intra-class correlation coefficients and pairwise by Bland-Altman analyses and 95% limits of agreement (LoA). Further, manual results were compared to a novel automatic QT-interval algorithm. ECGs of 1263 participants (720 LQTS patients; 543 controls) were available [median age 34 (inter-quartile range 35) years, 55% women]. Comparing cohort means, automatic and manual QT-intervals and QTc were similar. However, pairwise Bland-Altman-based agreement was highly discrepant. For QT-interval, LoAs spanned 95 (tangent) and 92 ms (threshold), respectively. For QTc, the spread was 108 and 105 ms, respectively. LQTS patients exhibited more pronounced differences. For automatic QTc results from 440-540 ms (tangent) and 430-530 ms (threshold), misassessment risk was highest. Novel automatic QT-interval algorithms may narrow this range.CONCLUSION: Pairwise vendor-provided automatic and manual QT-interval and QTc results can be highly discrepant. Novel automatic algorithms may improve agreement. Within the above ranges, automatic QT-interval and QTc results require manual confirmation, particularly if T-wave morphology is challenging.

KW - Humans

KW - Female

KW - Adult

KW - Male

KW - Electrocardiography

KW - Long QT Syndrome/diagnosis

KW - Death, Sudden, Cardiac/etiology

KW - Arrhythmias, Cardiac

KW - Risk Assessment

U2 - https://doi.org/10.1093/europace/euad213

DO - https://doi.org/10.1093/europace/euad213

M3 - Article

C2 - 37470430

SN - 1099-5129

VL - 25

JO - EP Europace

JF - EP Europace

IS - 9

ER -