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J Electrocardiol. 2015 Jan-Feb;48(1):12-8. doi: 10.1016/j.jelectrocard.2014.10.002. Epub 2014 Oct 18.

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

Author information

1
Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
2
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
3
Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel.
4
Center for Advanced Imaging, Mayo Clinic, Rochester, MN, USA.
5
Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
6
Division of Engineering, Mayo Clinic, Rochester, MN, USA.
7
Mayo Clinic Ventures, Mayo Clinic, Rochester, MN, USA.
8
Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address: friedman.paul@mayo.edu.

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 0.2mmol/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

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