Estimated preejection period (PEP) based on the detection of the R-wave and dZ/dt-min peaks in ECG and ICG

Abstract

The validity of estimating the PEP from a fixed value for the Q-wave onset to the R-wave peak (QR) interval and from the R-wave peak to the dZ/dt-min peak (ISTI) interval is evaluated. Ninety-one subjects participated in a laboratory experiment in which a variety of physical and mental stressors were presented and 31 further subjects participated in a sequence of structured ambulatory activities in which large variation in posture and physical activity was induced. PEP, QR interval, and ISTI were scored. Across the diverse laboratory and ambulatory conditions the QR interval could be approximated by a fixed interval of 40 ms but 95% confidence intervals were large (25 to 54 ms). Multilevel analysis showed that 79% to 81% of the within and between-subject variation in the RB interval could be predicted by the ISTI. However, the optimal intercept and slope values varied significantly across subjects and study setting. Bland-Altman plots revealed a large discrepancy between the estimated PEP and the actual PEP based on the Q-wave onset and B-point. It is concluded that the estimated PEP can be a useful tool but cannot replace the actual PEP to index cardiac sympathetic control.