Electrocardiogram to Determine Mitral and Aortic Valve Opening and Closure

M Rifqi Aufan; Zachary T Jost; Neal J Miller; Oleg F Sharifov; Himanshu Gupta; Gilbert J Perry; J Michael Wells; Thomas S Denney Jr; Steven G Lloyd

doi:10.1007/s13239-023-00664-4

Electrocardiogram to Determine Mitral and Aortic Valve Opening and Closure

Cardiovasc Eng Technol. 2023 Jun;14(3):447-456. doi: 10.1007/s13239-023-00664-4. Epub 2023 Mar 27.

Authors

M Rifqi Aufan¹, Zachary T Jost², Neal J Miller², Oleg F Sharifov², Himanshu Gupta^{2

3}, Gilbert J Perry², J Michael Wells^{2

4}, Thomas S Denney Jr⁵, Steven G Lloyd^{6

7}

Affiliations

¹ Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA.
² Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Valley Medical Group, Paramus, NJ, USA.
⁴ Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
⁵ Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.
⁶ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. slloyd@uabmc.edu.
⁷ Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA. slloyd@uabmc.edu.

PMID: 36971975
DOI: 10.1007/s13239-023-00664-4

Abstract

Purpose: Knowledge of the timing of cardiac valve opening and closing is important in cardiac physiology. The relationship between valve motion and electrocardiogram (ECG) is often assumed, however is not clearly defined. Here we investigate the accuracy of cardiac valve timing estimated using only the ECG, compared to Doppler echocardiography (DE) flow imaging as the gold standard.

Methods: DE was obtained in 37 patients with simultaneous ECG recording. ECG was digitally processed and identifiable features (QRS, T, P waves) were examined as potential reference points to determine opening and closure of aortic and mitral valves, as compared to DE outflow and inflow measurement. Timing offset of the cardiac valves opening and closure between ECG features and DE was measured from derivation set (n = 19). The obtained mean offset in combination with the ECG features model was then evaluated on a validation set (n = 18). Using the same approach, additional measurement was also done for the right sided valves.

Results: From the derivation set, we found a fixed offset of 22 ± 9 ms, 2 ± 13 ms, 90 ± 26 ms, and - 2 ± - 27 ms when comparing S to aortic valve opening, T_end to aortic valve closure, T_end to mitral valve opening, and R to mitral valve closure respectively. Application of this model to the validation set showed good estimation of aortic and mitral valve opening and closure timing value, with low model absolute error (median of the mean absolute error of the four events = 19 ms compared to the gold standard DE measurement). For the right-sided (tricuspid and pulmonic) valves in our patient set, there was considerably higher median of the mean absolute error of 42 ms for the model.

Conclusion: ECG features can be used to estimate aortic and mitral valve timings with good accuracy as compared to DE, allowing useful hemodynamic information to be derived from this easily available test.

Keywords: Aortic valve; Coronary artery disease; Doppler echo; ECG; Mitral valve.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aortic Valve* / diagnostic imaging
Aortic Valve* / physiology
Electrocardiography / methods
Hemodynamics
Humans
Mitral Valve / diagnostic imaging
Pulmonary Valve*

Grants and funding

R01 HL104018/HL/NHLBI NIH HHS/United States