# Patent

## Title
System and method for analyzing complex curvature of ECG curves

## Abstract

A system and a method for analysis of ECG curvature, which system involves a mathematical analysis comprising the following features where a number of different parameters are isolated and stored in a computer, where a first number of parameters are selected from at least one main group, where the selected parameters are combined in at least a first mathematical analysis. It is the object of the invention to improve mathematical analysis of ECG curvature particular for complex parts of the curvature such as notches or concavities. This can be achieved by selecting parameters from groups of symmetry, flatness, duration and/or complexity, using the parameters as input to an algorithm, where concavity intervals are evaluated on subsegments of the ECG segment and form the basis of up and downwards concavity quantification, where the system based on an algorithm detects and quantifies concavity on ECG curvatures.

## Background
FIELD OF THE INVENTION
The present invention relates to a system and a method for analysis of ECG curvature, which system involves a mathematical analysis, which mathematical analysis comprises at least the following features a number of different parameters are isolated and stored in a computer system, where the system comprises input means connected to at least one ECG source, where a first number of parameters are selected from at least one main group, which main groups comprise parameters of symmetry, flatness, duration and/or complexity, where the selected parameters are combined in at least a first mathematical analysis.
BACKGROUND OF THE INVENTION
An article describes Notched T Waves on Holter Recordings Enhance Detection of Patients With LQT2 (HERG) Mutations J. M. Lupoglazoff, MD; I. Denjoy, MD; M. Berthet; N. Neyroud, PhD; L. Demay; P. Richard, PhD; B. Hainque, PhD; G. Vaksmann, MD; D. Klug, MD; A. Leenhardt, MD; G. Maillard, MD; P. Coumel, MD; P. Guicheney, PhD
The 2 genes KCNQ1 (LQT1) and HERG (LQT2), encoding cardiac potassium channels, are the most common cause of the dominant long-QT syndrome (LQTS). In addition to QT-interval prolongation, notched T waves have been proposed as a phenotypic marker of LQTS patients. The T-wave morphology of carriers of mutations in KCNQ1 (n5133) or HERG (n557) and of 100 control subjects was analysed from Holter ECG recordings. Averaged T-wave templates were obtained at different cycle lengths, and potential notched T waves were classified as grade 1 (G1) in case of a bulge at or below the horizontal, whatever the amplitude, and as grade 2 (G2) in case of a protuberance above the horizontal. The highest grade obtained from a template defined the notch category of the subject. T-wave morphology was normal in the majority of LQT1 and control subjects compared with LQT2 (92%, 96%, and 19%, respectively, P, 0.001). G1 notches were relatively more frequent in LQT2 (18% versus 8% [LQT1] and 4% [control], P, 0.01), and G2 notches were seen exclusively in LQT2 (63%). Predictors for G2 were young age, missense mutations, and core domain mutations in HERG. This study provides novel evidence that Holter recording analysis is superior to the 12-lead ECG in detecting G1 and G2 T-wave notches. These repolarization abnormalities are more indicative of LQT2 versus LQT1, with G2 notches being most specific and often reflecting HERG core domain missense mutations. (Circulation. 2001; 103:1095-1101.)
Further is described Quantitative Analysis of T Wave Abnormalities and Their Prognostic Implications in the Idiopathic Long QT Syndrome GABRIELLA MALFATTO, MD,*t GABRIELLA BERIA, MD,*$ SERGIO SALA, MD,*t OSCAR BONAZZI, MD,* PETER J. SCHWARTZ, MD, FACC*§ Milan and Pavia, Italy.
We evaluated the diagnostic and prognostic value of morphologic abnormalities of the T wave (mainly notched or biphasic T waves) in patients affected by the idiopathic long QT syndrome. In the long QT syndrome, these abnormalities in T wave morphology are often observed and are of uncertain significance. The T wave abnormalities in the electrocardiogram (ECG) of 53 patients with the long QT syndrome and 53 control subjects of similar age and gender were analyzed, and their association with major cardiac events was defined. Notched or biphasic T waves were defined according to morphologic criteria. They were present in 33 (62%) of 53 patients with the long QT syndrome and in 8 (15%) of 53 control subjects (p<0.001). Moreover, among patients with the long QT syndrome they were much more frequent in symptomatic (history of syncope or cardiac arrest) than in asymptomatic subjects (30 [81%] of 37 vs. 3[19%] of 16, p<0.001). The same distribution was observed within families with the long QT syndrome, in which symptomatic members had more pronounced T wave abnormalities than did their asymptomatic siblings or parents. In symptomatic patients, the occurrence of T wave abnormalities was independent of the length of repolarization (corrected QT). These 'I wave abnormalities were associated with the presence of a specific pattern of abnormal left ventricular wall motion. This study has quantified an ECG pattern typical of the long QT syndrome and provides the first evidence that morphologic analysis of T wave abnormalities may contribute to the diagnosis of the long QT syndrome and the identification on patients at higher risk for syncope or cardiac arrest.
Further, an article entitled “T-wave “Humps” as a Potential Electrocardiographic Marker on the Long QT Syndrome” by MICHAEL H. LEHMANN, MD, FACC, FU-MIO SUZUKI, MD, BARBARA S. FROMM, MA, DEBRA FRANKOVICH, RN, PAUL ELKO, PhD, * RUSSEL T. STEINMAN, MD, FACC, JULIE FRESARD, RN, † JOHN J. BAGA, MD, R. THOMAS TAGGART PhD* is described.
This article describes a study attempted to determine the prevalence and electrocardiographic ECG lead distribution on T wave humps (T2 after an initial T wave peak, T1) among families with long QT syndrome and control subjects. T wave abnormalities have been suggested as another facet of familial long QT syndrome in addition to prolongation of the rate corrected QT interval (QTc) that might aid in the diagnosis of affected subjects. The ECG from 254 members of thirteen families with long QT syndrome (each with two or four generations of affected members) and from 2948 healthy control subjects (8≧16 years QTC intervals of 0.39 to 0.46 s) were collected and analysed. T2 was present in 53%, 27% and 5% of blood relatives with a prolonged QCT interval. These findings are consistent with hypothesis that in families with long QT syndrome, T wave humps involving left precordial or especially limps leads, even among asymptotic blood relatives with borderline QCT interval, suggested the presence of the long QT syndrome trait.
An article concerns Fractionated Repolarization Induced by Sotalol in Healthy Subjects M Vaglio, J P Couderc, X Xia, W Zareba Heart Research Follow-up-Program University of Rochester Medical Center, Rochester N.Y., USA.
Over the past five years, regulatory authorities have been increasingly concerned with QT prolongations induced by non-cardiac drug and have recommended pharmaceutical companies to include a careful assessment of the QT interval in their drug development programs. There are controversies around the predictive value of QT prolongation in safety-drug assessment studies. The prolongation of the QT interval is an imperfect, but accepted, surrogate marker of drug cardiac toxicity. In this study, we hypothesize that the inhomogeneous effect of QT prolonging drug in the different layers of the myocardium would not only delay cardiac repolarization, but also perturb the repolarization wavefront on surface ECGs. Principal component analysis (PCA) was applied to the L2-lead ECG Holter recordings. The first two eigenvectors (eu1, eu) were computed. From PCA, several parameters were calculated based on the first eigerwector and on the T-loop. We demonstrated slower repolarization and perturbed T-wave front; 30 min after sotalol administration, turbulence of repolarization velocity increased by 9.02%, p<0.05, occurring prior to QT prolongation. These abnormalities were mainly located in the ascending part of the T-wave, where as the descending part seemed to be less affected at this early phase. In conclusion, analyzing repolarization morphology might help identifying early drug-induced repolarization changes, which could be missed when relying exclusively on QT measurements.
The four mentioned articles all concern manual detection of ECG curvatures. Hundreds of curves have to be analysed manually in order to read the results mentioned in these articles. The manual method is effective for determination for a single patient, but only highly educated medical specialists are able to analyse the curvature. When such a judgement of ECG curvatures is only for specialists, they have to spend several hours per day just to analyse ECG curvatures. An open question is how effective even highly trained specialists are after having analysed curvatures for hours. There is always the risk that they overlook small deviations in the curvature. Due to a computerised curvature, analysis is much more effective, and a much higher number of curvatures can be analysed in a rather short period. There is not any risk that the computer system will overlook deviations in the curvature. A computerised system can make an effective selection between patients with deviations in the curvature and healthy people with a normal curvature.
EP 1 543 770 concerns a system or a method for analysing ECG curvature where at least one among a number of different parameters is isolated, which system has an input means connected to an ECG source, where the different parameters of a received ECG curvature are indicated and/or isolated and for indicating possible symptoms which relate to or are indications of certain deceases, where said deceases are known to influence the ECG curvature. First number of selected parameters are combined in at least a first mathematical analysis, where the result of the analysis can be represented as a point in a coordinate system comprising at least two axes where the system can compare the actual placement in the coordinate system with a number of reference parameters stored in the system for indicating diseases having influence on the ECG curvature. Hereby, it is achieved that any symptom of a disease having an indication (influence) in the ECG curvature can be detected in an objective and automated way.
WO 2005/058156 concerns a system or a method for analysing drug influence on ECG curvature and Long QT Syndrome where at least one among a number of different parameters is isolated, which system has a input means connected to an ECG source, where the different parameters of a received ECG curvature are indicated and/or isolated and for indicating possible symptoms which relates to or are indications of certain diseases, where said diseases are known to influence the ECG curvature. The aim of the invention is to achieve a system and a method for diagnosing Long QT Syndrome in an objective, fast and effective way by indication of a number of symptoms derivable from an ECG curve. Further aim of the invention is to achieve an effective test of drug influence on ECG curvature. This can be achieved with the system previously described if a first number of selected parameters is combined in at least a first mathematical analysis, where the result of the analysis can be represented as a point in a coordinate system comprising at least one axis where the system can compare the actual placement in the coordinate system with a number of reference parameters stored in the system for indicating symptoms or diseases having influence on the ECG curvature, where the system analyses the QT curvature of the ECG curvature for indicating Long QT syndrome. Hereby, it is achieved that any symptom of hereditary or acquired Long QT Syndrome having an indication (influence) in the ECG curvature can be detected in an objective, automated and very fast way.
US 2005/0234357 concern a method and apparatus for detecting cardiac repolarization abnormality using at least one electrocardiogram signal. The at least one electrocardiogram signal can be obtained from any number of continuous or non-continuous windows. The method can include deriving a total quantity of representative beats of the at least one electrocardiogram signal. At least one morphology shape descriptor can be used to determine a total quantity of values representing the total quantity of representative beats. Data corresponding to at least some of the total quantity of values can be used to assess cardiac repolarization abnormality.
U.S. Pat. No. 7,072,708 concerns a method in a computer system for detecting myocardial infarction including the steps of (a) receiving ECG data, (b) analyzing that data for the presence of benign ST data, and (c), when the ST data is not benign, (1) establishing a pathological threshold, (2) normalizing any deviation in the ECG data, (3) applying a pattern analysis to the normalized ECG data, and (4) generating a score indicating the presence of a myocardial infarction based on the pattern analysis and the threshold.
WO 2005/00269 concern implantable cardiac rhythm management device e.g. pacemaker, determines fundamental frequency of sampled signal by autocorrelating function of series of characteristic points each having time of lobe in curvature series. This can be achieved by estimating a frequency of a sampled cardiac rhythm signal and classifying the rhythm. The received signal is sampled and transformed into a curvature series. A lobe in the curvature series corresponds to a characteristic point in the sampled series. Characteristic points are selected based on a time of a lobe in the curvature series and, in one embodiment, amplitude of the signal at the time of the lobe. A frequency of the sampled series is estimated by autocorrelating a function of the series of the characteristic points. In one embodiment, the function is a time difference function. The rhythm is classified by plotting the timewise proximity of characteristic points derived from an atrial signal with characteristic points derived from a ventricular signal. Regions of the plot are associated with a particular rhythm and the grouping of the data corresponds to the classification.
OBJECT OF THE INVENTION
It is the object of the invention to improve mathematical analysis of ECG curvature particular for complex parts of the curvature such as notches or concavities.
It is a further object of the invention to improve automatic quantification of symmetry, flatness and durations of ECG curvature.
DESCRIPTION OF THE INVENTION
This can be achieved in a system as described in the preamble to claim 1 and further modified so that the parameters are selected from groups of symmetry (S1-S72), flatness (F1-91), duration (D1-D47) and/or complexity (C1-C468), where the mathematical analysis involves the action of extracting a segment of the ECG curvature, which segment is corresponding to the interval between defined electrocardiographic points, which segment is used as input to a first algorithm, where a second fiducial point algorithm automatically calculates fiducial points at the segment, where concavity intervals are evaluated on subsegments of the ECG segment and form the basis of up- and downwards concavity quantification, where the system based on the first and the second algorithm detects and quantifies concavity on ECG curvatures.
Herby can be achieved that a complex curvature can be analysed and the complex curvature might indicate symptoms of diseases which are very difficult to read on ECG curvature by existing technology. This can lead to a more precise analysis where existing systems might by analysing the curvature give a first indication of a symptom. By then performing an analysis of the complex part of the curvature, further symptoms might be indicated. This could lead in the direction of a more precise judgement of a disease. This can by computerised analysis of ECG curvature lead to a very limited overlap between curvatures judged as belonging to healthy persons and curvatures judged as belonging to persons carrying a disease. In normal computerised analysing, these overlaps might concern a relative great number of persons who have been analysed. Here, it is necessary to perform manual analysis of the ECG curvature and probably further medical analysis in order to make a clear decision of who carries a disease and who carries health. In the future, there will probably be developed further diseases specific symptoms based on complex deviations on ECG curvature.
At least one segment of the ECG repolarization signal can be selected, corresponding to the interval between the T wave onset and T wave offset, which segment is normalized so that the amplitude range (y) is equal to one in the selected interval. Hereby is achieved that on a selected part of the curvature between the T wave onset and the Twave offset is normalised show over the selected part of the curve the mean value of this curve will be a straight line. Deviations are the easy to read simply because they represent deviations from the straight line. It is to be understood that by a very primitive amplification of the signals these deviations on the straight line are very easy to amplify to a rather high value where even small deviations are easy to detect.
At least one segment of the ECG repolarization signal is selected, corresponding to the interval between the T wave onset and T wave offset, which segment is normalized so that the duration (x) is equal to one in the selected interval. Hereby is achieved that the duration is normalised. This can lead to a rather high amplification of the duration such that it is very easy to indicate any deviations where even small deviations will be amplified and in this way it is able to measure even very small deviations in the time domain.
The first and second derivatives with respect to time of the ECG repolarization segment are determined on the interval between the Twave onset and Twave offset, where the two derivative signals are subsequently used to calculate a radius of curvature (Rcurv) signal using the equation 1:




  
    
      
        Rcurv
        =
        
          -
          
            
              
                [
                
                  1
                  +
                  
                    
                      (
                      
                        
                          d
                          y
                        
                        
                          d
                          x
                        
                      
                      )
                    
                    2
                  
                
                ]
              
              
                3
                /
                2
              
            
            
              
                
                  d
                  2
                
                ⁢
                y
              
              
                d
                
                  x
                  2
                
              
            
          
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        1
      
    
  




where x is the timescale and y is the (ECG) signal. Hereby is achieved that a calculation of the radius of a curvature is achieved.

Local maxima (LmRcurv) on the Rcurv signal between any two repolarization fiducial points is determined to identify places of local downwards concavity on a repolarization segment of an ECG. Hereby is achieved that the points of local maximum is identified in a highly effective way.
Local minima on the Rcurv signal between any two repolarization fiducial points are determined to identify places of local upwards concavity on a repolarization segment of an ECG. Hereby is achieved that the point of local minima is identified in a highly effective way.
The peak of the Twave (Tpeak) typically constitutes a local maximum of the Rcurv signal. The Rcurv signal can be analyzed further to investigate if further maxima and minima exist. If a contiguous configuration of local maximum neighbored by local minimum exists on the Rcurv signal, this may be indicative of a notch or hump on the ECG signal. The value of the Rcurv signal in the relevant maximum and minimum may be evaluated to quantify the size of the notch or hump on the ECG signal. Hereby is achieved a simple and robust method for identifying and quantifying notches and humps on the ECG signal.
A window can be defined in a curve segment starting at a first defined period before T wave peak and ending at a second defined period after T wave peak, in which window the curvature is excluded from further analysis of the Rcurv signal, and where any number of LmRcurv signal values with amplitudes below zero is excluded from further analysis, where any number of LmRcurv signal values, which correspond in time to ECG repolarization amplitudes below any given threshold are excluded from further analysis. Hereby is achieved that certain areas of a curvature are blanked out from the analysis. These areas are probably that part of the curvature which contains the most noise, and which contains relative new information in that part of the curvature.
Positive segment durations on the Rcurv on either side of all reference points are multiplied by the value of the corresponding LmRcurv values to obtain certainty measures (Cm) of the presence of local downward concavities. Hereby, it is achieved that the downward concavities are multiplied by a factor such that they become visible also for the further analysis of the curvature.
Certainty measures exceeding a threshold (Thr) are defined as places around which concavity intervals are defined and local downward concavities are quantified. By using a threshold value, it can be achieved that very small downward concavities are blanked out of the analysis. This might be done simply because some of very small downward concavities are results from noise which has been generated may be in the human body of may be electrical noise induced in the system.
No certainty measures exceeding a threshold (Thr) are present, where a first subsegment is generated by two piecewise tilted segments, where a first tilted subsegment (T1tilt) is given by the repolarization interval between the T wave onset and T wave peak from which the linear function between the two endpoints is subtracted, where a second tilted subsegment (T2tilt) is given by the repolarization interval between the T wave peak and T wave offset from which the linear function between the two endpoints is subtracted.
An upwards concavity score is calculated, where the least negative maximum on either piecewise repolarization subsegment is used as an initial upwards concavity score (IuS), which score is corrected to obtain a final upwards concavity score (CuS) of zero when any certainty measure equals the certainty threshold and a final CuS score equal to IuS when no LmRcurv points remain after the exclusion criteria step, where the relationship is given by equation 3.




  
    
      
        CuS
        =
        
          
            IuS
            ⁡
            
              (
              
                1
                -
                
                  Cm
                  Thr
                
              
              )
            
          
          .
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        3
      
    
  




Hereby is achieved that upward concavity is measured.
A subsegment can be generated by two piecewise tilted segments, where a first tilted subsegment is given by the repolarization interval between the T wave onset and T wave peak from which the linear function between the two endpoints is subtracted, where a second tilted subsegment is given by the repolarization interval between the T wave peak and T wave offset from which the linear function between the two endpoints is subtracted. By subtracting the linear relation between the starting point and the top point, all deviations from the linear relation in the up going and the down going curve will be amplified in a way where they are very easy to detect.
On both of the tilted subsegments and all concavity intervals are evaluated and maximum values (T1tiltmax) and (T2tiltmax) on the tilted subsegments in the concavity intervals are determined, where the overall maximum value is the final concave down score (CdS) of the ECG repolarization segment given by equation 2:

CdS=max([T1tilt maxT2tilt max]).  Equation 2

Hereby is achieved that a highly effective measurement of concavity is achieved, which is more indicative of disease or drug influence than manual inspection of ECG curvature.
The peakedness of the T wave peak (Peak_Curvature) is evaluated by calculating the radius of curvature value (Rcurv) in T peak, which radius of curvature is given by:




  Rcurv
  =
  
    -
    
      
        
          [
          
            1
            +
            
              
                (
                
                  
                    d
                    y
                  
                  
                    d
                    x
                  
                
                )
              
              2
            
          
          ]
        
        
          3
          /
          2
        
      
      
        
          
            d
            2
          
          ⁢
          y
        
        
          d
          
            x
            2
          
        
      
    
  




where x is the timescale normalized with the T wave width, and y is the ECG signal normalized with the T wave amplitude. Hereby is achieved that the curvature of the peak of the T wave is calculated in an effective way.

The symmetric properties of the T wave are evaluated by comparing the T wave curve on the right side of T peak with the T wave curve on the left side of T peak, which comparison of left and right side is performed at any representation of the T wave, such as the time domain ECG signal, the first derivative of the signal, the second derivative of the signal or any combination of these such as the radius of curvature of the signal Rcurv. Hereby, a highly effective measurement for symmetry is achieved.
The T wave representation of the right side of T peak is flipped around a vertical line through T peak to cover the left side of T peak. In this way, a very easy mathematical calculation can be performed for measuring the symmetry.
A first or second derivative is used for the mathematical analysis, where the T wave representation of the right side of T peak is flipped around the x axis to compensate for the sign difference between the two sides. Hereby, is achieved a highly effective mathematical analysis.
Preferably the system can analyse ECG curvature for drug influence. Drug has often influence on the ECG curvature. For analysing drug, it could be very effective to use an analysis also on the complex part of the ECG curvature in order to indicate negative symptoms by testing new forms for drug.
The system can analyse an ECG curvature for Long QT Syndrome. A system as described in this patent application can very effectively investigate a high number of test persons for long QT syndrome. Especially an analysis using this system will be highly effective because together with a change in the QT also complex changes in the curvature might occur.
The invention further concerns a method for analyse of ECG curvature, which method determines a number of parameters, where the method for analysing the ECG curvature at least incorporates the steps of receiving at least one ECG curvature from at least one source, indicating a number of different parameters determined from the received ECG curvature, storing the parameters in storage means, selecting disease specific parameters in the storage means, selecting a first number of parameters from at least one main group, which main groups comprise parameters of symmetry, flatness, duration and/or complexity, combining the selected parameters in at least a first mathematical analysis, where the mathematical analysis is extracting a segment of the ECG curvature, which segment is corresponding to the interval between defined electrocardiographic points, which mathematical analysis uses the segment as input to an first algorithm to calculate fiducial points at the segment, by a second fiducial point algorithm, which mathematical analysis normalizes the segment of the ECG curvature corresponding to the interval between defined electrocardiographic points in relation to at least one selected parameter, which mathematical analysis evaluates concavity intervals on subsegments of the ECG segment and form the basis of upwards and downwards concavity quantification, which mathematical analysis indicates symptoms of electrocardiographic abnormalities by detection and quantification of at least one concavity of an ECG curvature.
This method could lead to a very effective automatic analysis of ECG curvature. After the analysis of an ECG curvature, the system can communicate with a database containing equal ECG results where a new test of a curvature can be compared with a high number of previous tests of curvatures. In this way, symptoms of the curvature can easily be detected for a patient and related to a specific disease. Also in the drug test, this method can be highly effective. Some kinds of drugs might have an influence on the ECG curvature, but this influence consists only of very small deviations in the curvature. These very small deviations are not being measured in the previous known systems. By using this method, an analysis of a complex part of the curvature is possible.



DESCRIPTION OF THE DRAWING
FIG. 1. Flow diagram of algorithm.
FIG. 2. Normalized ECG segment from J-point+80 ms to the following Pwave onset. Fiducial points Twave onset, Twave peak and Twave offset are indicated by vertical dashed lines.
FIG. 3. Local maxima (LmRcurv) on the radius of curvature signal (Rcurv) indicated by red+marks. Values inside the Twave peak window on the Rcurv are set to equal one and are not used for further analysis.
FIG. 4. Downwards concavity certainty measures (Cm) indicated by red stems.
FIG. 5. shows concavity intervals around a certainty measure that given by all combinations of intervals between local maxima on the second derivative signal.
FIG. 6. Tilted subsegments T1tilt and T2tilt.
FIG. 7. Final maximum downwards concavity interval. Downwards concavity score (CdS) is given by the maximum difference between the angled line and the Twave
FIG. 8. Concavity scores for the electrocardiographic lead V5
FIG. 9 Concave down curvature segment
FIG. 10 Concave down curvature segment
FIG. 11 Concave down curvature segment
FIG. 12 Concave down curvature segment
FIG. 13 Concave down curvature segment
FIG. 14 Concave down curvature segment
FIG. 15 Concave down curvature segment
FIG. 16 Concave down curvature segment
FIG. 17 Concave down curvature segment
FIG. 18 Concave down curvature segment
FIG. 19 Concave down curvature segment
FIG. 20 shows the notch score reflects the size of any visible notches on the T-wave.



DETAILED DESCRIPTION OF THE INVENTION
1.1 Parameters for Quantifying Morphology of ECG Curvatures
The Long QT Syndrome is a genetic disorder characterized by abnormal cardiac repolarisation. In congenital LQTS, mutations in the KvLQT1- and HERG genes accounts for more than 90% of all LQTS patients.
The abnormality in the repolarisation is reflected in the ECG curves, where the morphology of the T-wave changes regarding to different LQT mutations.
Studies have shown that T-wave morphology parameters are useful discriminators, but no single parameter has shown to be sufficient. However multivariate discrimination method based on combination of T-wave symmetry-, flatness, duration- and complexity parameters, has shown to be a powerful tool.
Various drugs give rise to an influence on the ECG curves, and often similar T-wave morphology changes as seen to LQT patients with mutation in the HERG genes. For that reason quantifying of the morphology changes, in pre-market drug testing would give valuable information in making the decision, whether is should get on the market or not.
Morphology parameters in the groups, symmetry, flatness, duration and complexity gives valuable information about these morphology changes, both as single parameters but especially combined in a multivariate discrimination method.
Patients with mutation in the HERG genes, often have a more convex pattern on the up- and/or down-slope of the T-wave than healthy subjects. Sometimes HERG patients ECG shows a distinct notch on the up- or down-slope of the T-wave.
The group of parameter called complexity comprises i.a. of parameters which measures these complex patterns in the curvature.
By that we mean a measure that describes the concavity versus convexity of respectively the up- and down slope. This is like an overall measure of the up- or down-slopes curve pattern.
Besides that the complexity is also bumpiness/notchness or a distinct notch, which is just a more local concavity or convexity on the curve pattern.
In the following a mathematical description is given of the parameter, which measure these convexity and concavity, whether it's overall or local.
1.2 FIG. 1 Shows a Flow Diagram of a Algorithm for Detection and Quantification of Repolarization Concavity on the ECG
During repolarization an ECG curvature may be concave up or concave down or it may change between the two forms of concavities. An algorithm has been developed to detect and quantify these two forms of concavity on an ECG during repolarization.
An ECG segment of the repolarization process including as a minimum, the entire electrocardiographic T wave from any one electrocardiographic lead or any composite lead can be used as input to the algorithm. Also, the definitions of repolarization fiducial points such as T wave onset, T wave peak, T wave offset and other repolarization fiducial points can be given by any existing fiducial point detection algorithm, or repolarization fiducial points may be determined by manually.
The algorithm may normalize an ECG repolarization segment in such a way that the amplitude range (y) between any two fiducial points is equal to one. The algorithm may further normalize the duration of the ECG repolarization segment in such a way that the duration (x) between any two repolarization fiducial points is equal to one.
The first and second derivatives of the ECG repolarization segment can be determined and both derivative measures may be used to calculate a radius of curvature (Rcurv) signal between any two repolarization fiducial points. The Rcurv signal can be obtained as follows:




  
    
      
        Rcurv
        =
        
          -
          
            
              
                [
                
                  1
                  +
                  
                    
                      (
                      
                        
                          d
                          y
                        
                        
                          d
                          x
                        
                      
                      )
                    
                    2
                  
                
                ]
              
              
                3
                /
                2
              
            
            
              
                
                  d
                  2
                
                ⁢
                y
              
              
                d
                
                  x
                  2
                
              
            
          
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        1
      
    
  




Local maxima (LmRcurv) on the Rcurv signal between any two repolarization fiducial points can be determined. Any number of local maxima in a window of varying duration around a given definition of Twave peak may be excluded from further analysis of the Rcurv signal. Any number of LmRcurv signal values with amplitudes below zero may be excluded from further analysis. Any number of LmRcurv signal values, which correspond in time to ECG repolarization amplitudes below any given threshold may be excluded from further analysis.
All LmRcurv values that have not been excluded from further analysis can be used to identify places of local downwards concavity on a repolarization segment of an ECG. Identified places of local downwards concavity subsequently can form the basis for quantification of local downwards concavity on a repolarization segment of an ECG.
The extent of downwards concavity on an ECG repolarization segment can be evaluated at identified places of local downwards concavity or in intervals around places of identified local downwards concavity.
Piecewise tilted subsegments of a longer ECG repolarization segment may be used to obtain measures of local downward concavities. Piecewise tilted subsegments of a longer ECG repolarization segment may also be used to obtain measures of local upward concavities. The extent of all local downward concavities and local upward concavities on an ECG repolarization segment can be used to obtain a final overall quantitative measure of concavity for that ECG repolarization segment.
A flow diagram of the algorithm is provided in FIG. 1.
1.3 Application Example: Detection and Quantification of Repolarization Concavity on the ECG
An ECG segment of the repolarization process corresponding to the interval between the electrocardiographic J-point+80 ms and the following electrocardiographic Pwave onset is extracted and used as input to the algorithm.
The Twave onset, Twave peak and Twave offset fiducial points are determined automatically by an existing fiducial point detection algorithm.
A segment of the ECG repolarization signal corresponding to the interval between the Twave onset and Twave offset is normalized so that the amplitude range (y) is equal to one in that interval. A segment of the ECG repolarization signal corresponding to the interval between the Twave onset and Twave offset is normalized so that the duration (x) is equal to one in that interval, FIG. 2.
The first and second derivatives of the ECG repolarization segment are determined on the interval between the Twave onset and Twave offset. The two derivative signals are subsequently used to calculate a radius of curvature (Rcurv) signal using equation 1. In one embodiment of the invention local maxima and local minima on the Rcurv signal between Twave onset (Tonset) and Twave offset (Toffset) are determined. The peak of the Twave (Tpeak) typically constitutes a local maximum of the Rcurv signal. The signal is analysed further to investigate if further maxima and minima exist. Any deflections on the Rcurv signal correspond to deviations from the normal, smooth progress of a T-wave. The Rcurv signal is normalized to get a maximum amplitude of 1. A notch or hump is reflected as a contiguous positive-negative pair on the Rcurv signal and when such a pair is present, a notch score is defined as the positive peak value of this pair. If no notches are present, the score is 0.
In another embodiment for the invention, local maxima (LmRcurv) on the Rcurv signal between the Twave onset and Twave offset are determined, excluding LmRcurv points in a window symmetric around the Twave peak. The width of the window is set to twice the maximum duration of the return of Twave amplitude to 95% of the Tpeak value on either side of the Twave peak, or 20 ms, whichever is smaller. LmRcurv points with values below zero are also excluded as well as LmRcurv points, which correspond in time to ECG repolarization amplitudes below 40% of the maximum value of the normalized repolarization segment, FIG. 3.
The LmRcurv points that are left after exclusion according to the above given criteria are reference points. Positive segment durations on the Rcurv on either side of all reference points are multiplied by the value of the corresponding LmRcurv values to obtain certainty measures (Cm) of the presence of local downward concavities. Certainty measures exceeding a threshold of 15 (Thr15) are defined as places around which concavity intervals are defined and local downward concavities are quantified, FIG. 4.
Concavity intervals around a certainty measure that exceeds Thr15 are given by all combinations of intervals between local maxima on the second derivative signal, FIG. 5.
In the case when a certainty measure is not located between two local maxima on the second derivative signal, additional concavity interval combinations are made using the Twave onset, Twave offset or the first point outside the Twave peak window.
The concavity intervals are evaluated on subsegments of the ECG repolarization segment and form the basis of downwards concavity quantification. Two piecewise tilted segments make up the subsegments. One tilted subsegment (T1tilt) is given by the repolarization interval between the Twave onset and Twave peak from which the linear function between the two endpoints is subtracted. The other tilted subsegment (T2tilt) is given by the repolarization interval between the Twave peak and Twave offset from which the linear function between the two endpoints is subtracted, FIG. 6.
On both of the tilted subsegments all concavity intervals shown in FIG. 5 are evaluated and maximum values (T1tiltmax) and (T2tiltmax) on the tilted subsegments in the concavity intervals are determined. The overall maximum value is the final concave down score (CdS) of the ECG repolarization segment given by equation 2 and shown indicated in FIG. 7.

CdS=max([T1tilt maxT2tilt max])  Equation 2

On repolarization segments where no LmRcurv points are present or in case no LmRcurv points remain after the exclusion criteria, a upwards concavity score is calculated. The least negative maximum on either piecewise repolarization subsegment is used as an initial upwards concavity score (IuS). This score is then corrected in such a way as to obtain a final upwards concavity score (CuS) of zero when any certainty measure equals the certainty threshold and a final CuS score equal to IuS when no LmRcurv points remain after the exclusion criteria step. This relationship is given by equation 3.




  
    
      
        CuS
        =
        
          IuS
          ⁡
          
            (
            
              1
              -
              
                Cm
                
                  Thr
                  15
                
              
            
            )
          
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        3
      
    
  




All positive concavity scores indicate the presence of a concave down curvature on the ECG repolarization signal. The magnitude of a positive CdS value reflects the extent of downwards concavity on an ECG repolarization segment. All negative concavity scores indicate that no significant downwards concave segments were identified on the ECG repolarization segment. The magnitude of a negative CuS value reflects the extent of upwards concavity on an ECG repolarization segment.
The method described above has been used to obtain concavity scores for 1093 ECG repolarization segments from verified healthy normal subjects and 117 ECG repolarization segments from genotyped congenital Long QT Syndrome subjects with mutations on the HERG gene. Concavity scores for a standard V5 lead are given in FIG. 8. Specificity and sensitivity for lead V5 were 93.6% and 89.4% respectively. Specificity and sensitivity using a composite lead were 95.8% and 83.8% respectively. The method has multiple application areas and may also be used to detect and quantify repolarization concavity in the acquired form of the Long QT syndrome and in patients with other electrocardiographic repolarization abnormalities
FIGS. 9-18 show examples of various concave down curvatures detected and quantified by the algorithm.
FIG. 19 shows the asymmetry score evaluates differences in slope profile and duration of the ascending and descending part of the T-wave. In one embodiment, the first derivative of the filtered T-wave is calculated and divided into two segments corresponding to ascending and descending T-wave. Both segments are normalized with the maximum amplitude of the first derivative within each segment. Then the descending T-wave segment is flipped across the y-axis and x-axis to cover the ascending segment. The segments are compared sample by sample, and the asymmetry score is the average residual between the two segments.
FIG. 20 shows the notch score reflects the size of any visible notches on the T-wave. In one embodiment, the score is obtained from the inverse, signed radius of curvature (Rcurv) of the T-wave. Any deflections on this signal correspond to deviations from the normal, smooth progress of a T-wave. The Rcurv signal is normalized to get a maximum amplitude of 1. A true notch is reflected as an up-down pair on the Rcurv signal and when such a pair is present, the notch score is defined as the positive peak value of this pair. If no notches are present, the score is 0.
1.4 Peak_Curvature
The peakedness of the T wave peak (Peak_Curvature) is evaluated by calculating the radius of curvature value (Rcurv) in Tpeak.
The radius of curvature is given by:




  
    Rcurv
    =
    
      -
      
        
          
            [
            
              1
              +
              
                
                  (
                  
                    
                      d
                      y
                    
                    
                      d
                      x
                    
                  
                  )
                
                2
              
            
            ]
          
          
            3
            /
            2
          
        
        
          
            
              d
              2
            
            ⁢
            y
          
          
            d
            
              x
              2
            
          
        
      
    
  
  ,




where x is the timescale normalized with the T wave width, and y is the ECG signal normalized with the T wave amplitude.

1.5 Symmetry Residual

The symmetric properties of the T wave are evaluated by comparing the T wave curve on the right side of Tpeak with the T wave curve on the left side of Tpeak.
The comparison of left and right side is done on any representation of the T wave, such as the time domain ECG signal, the first derivative of the signal, the second derivative of the signal or any combination of these such as the radius of curvature of the signal (Rcurv as described above).
The Twave representation of the right side of Tpeak is flipped around a vertical line through Tpeak to cover the left side of Tpeak. If first or second derivative is used, the Twave representation of the right side of Tpeak is also flipped around the x axis to compensate for the sign difference between the two sides.
If the lengths of the two representations (left side and flipped right side) differ, this is corrected either by resampling each side to a common length or by zero-padding the shortest side to fit the length of the other.
Prior to the comparison the two representations can be normalized with their respective amplitude to give a better fit.
The two representations are now compared sample by sample. A residual is calculated by evaluating the summed sample-by-sample difference between the two representations. The difference can be absolute or squared before summing.
The total residual is a reliable measure of the symmetry of T wave.
1.6 Parameter Description
Symmetry


    
    
        S1 Skewness evaluated in a symmetric interval, 30% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S2 Skewness evaluated in a symmetric interval, 40% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S3 Skewness evaluated in a symmetric interval, 50% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S4 Skewness evaluated in a symmetric interval, 60% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S5 Skewness evaluated in a symmetric interval, 70% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S6 Skewness evaluated in a symmetric interval, 80% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S7 Skewness evaluated in a symmetric interval, 90% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S8 Skewness evaluated in a symmetric interval, 100% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        S9 Skewness evaluated from Tstart toTend
        S10 Skewness evaluated in a symmetric interval, 10% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S11 Skewness evaluated in a symmetric interval, 20% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S12 Skewness evaluated in a symmetric interval, 30% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S13 Skewness evaluated in a symmetric interval, 40% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S14 Skewness evaluated in a symmetric interval, 50% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S15 Skewness evaluated in a symmetric interval, 60% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S16 Skewness evaluated in a symmetric interval, 70% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S17 Skewness evaluated in a symmetric interval, 80% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S18 Skewness evaluated in a symmetric interval, 90% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S19 Skewness evaluated in a symmetric interval, 100% of the Tstart-Tend interval, surrounding Center of Mass (CoM)
        S20 Skewness evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to Tend, and Tend at 98% of the area.
        S21 Skewness evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to Tend, and Tend at 95% of the area.
        S22 Skewness evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to Tpeak, and Tend at 98% of the area from Tpeak to Tend.
        S23 Skewness evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to Tpeak, and Tend at 95% of the area from Tpeak to Tend.
        S24 Skewness evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to CoM, and Tend at 98% of the area from CoM to Tend.
        S25 Skewness evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to CoM, and Tend at 95% of the area from CoM to Tend.
        S26 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 10% of the Tstart-TCoM interval, and on the right side 10% of the TCoM-Tend interval
        S27 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 20% of the Tstart-TCoM interval, and on the right side 20% of the TCoM-Tend interval
        S28 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 30% of the Tstart-TCoM interval, and on the right side 30% of the TCoM-Tend interval
        S29 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 40% of the Tstart-TCoM interval, and on the right side 40% of the TCoM-Tend interval
        S30 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 50% of the Tstart-TCoM interval, and on the right side 50% of the TCoM-Tend interval
        S31 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 60% of the Tstart-TCoM interval, and on the right side 60% of the TCoM-Tend interval
        S32 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 70% of the Tstart-TCoM interval, and on the right side 70% of the TCoM-Tend interval
        S33 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 80% of the Tstart-TCoM interval, and on the right side 80% of the TCoM-Tend interval
        S34 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 80% of the Tstart-TCoM interval, and on the right side 90% of the TCoM-Tend interval
        S35 Skewness evaluated in a asymmetric interval, which on the left side of Center of Mass(CoM) consist of, 100% of the Tstart-TCoM interval, and on the right side 100% of the TCoM-Tend interval
        S36 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 10% of the Tstart-TPeak interval, and on the right side 10% of the TPeak-Tend interval
        S37 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 20% of the Tstart-TPeak interval, and on the right side 20% of the TPeak-Tend interval
        S38 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 30% of the Tstart-TPeak interval, and on the right side 30% of the TPeak-Tend interval
        S39 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 40% of the Tstart-TPeak interval, and on the right side 40% of the TPeak-Tend interval
        S40 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 50% of the Tstart-TPeak interval, and on the right side 50% of the TPeak-Tend interval
        S41 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 60% of the Tstart-TPeak interval, and on the right side 60% of the TPeak-Tend interval
        S42 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 70% of the Tstart-TPeak interval, and on the right side 70% of the TPeak-Tend interval
        S43 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 80% of the Tstart-TPeak interval, and on the right side 80% of the TPeak-Tend interval
        S44 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 90% of the Tstart-TPeak interval, and on the right side 90% of the TPeak-Tend interval
        S45 Skewness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 100% of the Tstart-TPeak interval, and on the right side 100% of the TPeak-Tend interval
        S46 Symmetry parameters, S1-S45, normalized by the size of the QRS amplitude
        S47 The area of the T-wave calculated in the interval from Tstart to Tend
        S48 Symmetry parameter, S47, normalized by the size of the QRS amplitude.
        S49 The area of the T-wave calculated in the interval from Tpeak to Tend
        S50 Symmetry parameter, S49, normalized by the size of the QRS amplitude.
        S51 The area of the T-wave calculated in the interval from Tstart to TPeak
        S52 Symmetry parameter, S51, normalized by the size of the QRS amplitude.
        S53 Ratio of the area calculated in the interval from Tstart to Tpeak and the area calculated in the interval from Tpeak to Tend.
        S54 Ratio of the total area of the Twave and the tail area, where the tail area in the case that the duration of Tstart-Tpeak>duration of Tpeak-Tend, is the area in the interval from Tstart to Tpeak−(Tend−Tpeak), and vice versa.
        S55 Symmetry residual of the Twave parts, respectively from Tstart-Tpeak and Tpeak-Tend
        S56 Symmetry residual of the first derivative of the Twave parts, respectively from Tstart-Tpeak and Tpeak-Tend
        S57 Symmetry residual of the second derivative of the Twave parts, respectively from Tstart-Tpeak and Tpeak-Tend
        S58 Symmetry parameter, S55, normalizing the interval Tstart-Tpeak and Tpeak-Tend by resampling both.
        S59 Symmetry parameter, S55, normalizing the interval Tstart-Tpeak and Tpeak-Tend by zero padding the interval with the shortest duration
        S60 Symmetry parameter, S56, normalizing the interval Tstart-Tpeak and Tpeak-Tend by resampling both.
        S61 Symmetry parameter, S56, normalizing the interval Tstart-Tpeak and Tpeak-Tend by zero padding the interval with the shortest duration
        S62 Symmetry parameter, S57, normalizing the interval Tstart-Tpeak and Tpeak-Tend by resampling both.
        S63 Symmetry parameter, S57, normalizing the interval Tstart-Tpeak and Tpeak-Tend by zero padding the interval with the shortest duration
        S64 Symmetry parameter, S55, normalized by their respective amplitude
        S65 Symmetry parameter, S56, normalized by their respective amplitude
        S66 Symmetry parameter, S57, normalized by their respective amplitude
        S67 Symmetry parameter, S58, normalized by their respective amplitude
        S68 Symmetry parameter, S59, normalized by their respective amplitude
        S69 Symmetry parameter, S60, normalized by their respective amplitude
        S70 Symmetry parameter, S61, normalized by their respective amplitude
        S71 Symmetry parameter, S62, normalized by their respective amplitude
        S72 Symmetry parameter, S63, normalized by their respective amplitude

Flatness

        F1 Flatness with Tpeak as mean evaluated in a symmetric interval of 30% of the Tstart-Tend interval surrounding Tpeak.
        F2 Flatness parameter, F1, normalized by the size of the QRS amplitude.
        F3 Flatness with Tpeak as mean evaluated in a symmetric interval of 40% of the Tstart-Tend interval surrounding Tpeak.
        F4 Flatness parameter, F3, normalized by the size of the QRS amplitude.
        F5 Flatness with Tpeak as mean evaluated in a symmetric interval of 50% of the Tstart-Tend interval surrounding Tpeak.
        F6 Flatness parameter, F5, normalized by the size of the QRS amplitude.
        F7 Flatness with Tpeak as mean evaluated in a symmetric interval of 60% of the Tstart-Tend interval surrounding Tpeak.
        F8 Flatness parameter, F7, normalized by the size of the QRS amplitude.
        F9 Flatness with Tpeak as mean evaluated in a symmetric interval of 70% of the Tstart-Tend interval surrounding Tpeak.
        F10 Flatness parameter, F9, normalized by the size of the QRS amplitude.
        F11 Flatness with Tpeak as mean evaluated in a symmetric interval of 80% of the Tstart-Tend interval surrounding Tpeak.
        F12 Flatness parameter, F11, normalized by the size of the QRS amplitude.
        F13 Flatness with Tpeak as mean evaluated in a symmetric interval of 90% of the Tstart-Tend interval surrounding Tpeak.
        F14 F14 Flatness parameter, F13, normalized by the size of the QRS amplitude.
        F15 Flatness with Tpeak as mean evaluated in a symmetric interval of 100% of the Tstart-Tend interval surrounding Tpeak.
        F16 Flatness parameter, F15, normalized by the size of the QRS amplitude.
        F17 Flatness with Tpeak as mean from Tstart to Tend
        F18 Flatness parameter, F17, normalized by the size of the QRS amplitude.
        F19 Flatness evaluated in a symmetric interval of 10% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F20 Flatness parameter, F19, normalized by the size of the QRS amplitude
        F21 Flatness evaluated in a symmetric interval of 20% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F22 Flatness parameter, F21, normalized by the size of the QRS amplitude
        F23 Flatness evaluated in a symmetric interval of 30% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F24 Flatness parameter, F23, normalized by the size of the QRS amplitude
        F25 Flatness evaluated in a symmetric interval of 40% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F26 Flatness parameter, F25, normalized by the size of the QRS amplitude
        F27 Flatness evaluated in a symmetric interval of 50% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F28 Flatness parameter, F27, normalized by the size of the QRS amplitude
        F29 Flatness evaluated in a symmetric interval of 60% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F30 Flatness parameter, F29, normalized by the size of the QRS amplitude
        F31 Flatness evaluated in a symmetric interval of 70% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F32 Flatness parameter, F31, normalized by the size of the QRS amplitude
        F33 Flatness evaluated in a symmetric interval of 80% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F34 Flatness parameter, F33, normalized by the size of the QRS amplitude
        F35 Flatness evaluated in a symmetric interval of 90% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F36 Flatness parameter, F35, normalized by the size of the QRS amplitude
        F37 Flatness evaluated in a symmetric interval of 100% of the Tstart-Tend interval surrounding Center of Mass (CoM)
        F38 Flatness parameter, F37, normalized by the size of the QRS amplitude
        F39 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 10% of the Tstart-TPeak interval, and on the right side 10% of the TPeak-Tend interval
        F40 Flatness parameter, F39, normalized by the size of the QRS amplitude
        F41 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 20% of the Tstart-TPeak interval, and on the right side 20% of the TPeak-Tend interval
        F42 Flatness parameter, F41, normalized by the size of the QRS amplitude
        F43 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 30% of the Tstart-TPeak interval, and on the right side 30% of the TPeak-Tend interval
        F44 Flatness parameter, F43, normalized by the size of the QRS amplitude
        F45 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 40% of the Tstart-TPeak interval, and on the right side 40% of the TPeak-Tend interval
        F46 Flatness parameter, F45, normalized by the size of the QRS amplitude
        F47 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 50% of the Tstart-TPeak interval, and on the right side 50% of the TPeak-Tend interval
        F48 Flatness parameter, F47, normalized by the size of the QRS amplitude
        F49 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 60% of the Tstart-TPeak interval, and on the right side 60% of the TPeak-Tend interval
        F50 Flatness parameter, F49, normalized by the size of the QRS amplitude
        F51 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 70% of the Tstart-TPeak interval, and on the right side 70% of the TPeak-Tend interval
        F52 Flatness parameter, F51, normalized by the size of the QRS amplitude
        F53 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 80% of the Tstart-TPeak interval, and on the right side 80% of the TPeak-Tend interval
        F54 Flatness parameter, F53, normalized by the size of the QRS amplitude
        F55 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 90% of the Tstart-TPeak interval, and on the right side 90% of the TPeak-Tend interval
        F56 Flatness parameter, F55, normalized by the size of the QRS amplitude
        F57 Flatness evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 100% of the Tstart-TPeak interval, and on the right side 100% of the TPeak-Tend interval
        F58 Flatness parameter, F57, normalized by the size of the QRS amplitude
        F59 Flatness evaluated in a asymmetric interval, which on the left side of Center of Mass (CoM) consist of, 10% of the Tstart-TCoM interval, and on the right side 10% of the TCoM-Tend interval
        F60 Flatness parameter, F59, normalized by the size of the QRS amplitude
        F61 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 20% of the Tstart-TCoM interval, and on the right side 20% of the TCoM-Tend interval
        F62 Flatness parameter, F61, normalized by the size of the QRS amplitude
        F63 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 30% of the Tstart-TCoM interval, and on the right side 30% of the TCoM-Tend interval
        F64 Flatness parameter, F63, normalized by the size of the QRS amplitude
        F65 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 40% of the Tstart-TCoM interval, and on the right side 40% of the TCoM-Tend interval
        F66 Flatness parameter, F65, normalized by the size of the QRS amplitude
        F67 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 50% of the Tstart-TCoM interval, and on the right side 50% of the TCoM-Tend interval
        F68 Flatness parameter, F67, normalized by the size of the QRS amplitude
        F69 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 60% of the Tstart-TCoM interval, and on the right side 60% of the TCoM-Tend interval
        F70 Flatness parameter, F69, normalized by the size of the QRS amplitude
        F71 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 70% of the Tstart-TCoM interval, and on the right side 70% of the TCoM-Tend interval
        F72 Flatness parameter, F71, normalized by the size of the QRS amplitude
        F73 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 80% of the Tstart-TCoM interval, and on the right side 80% of the TCoM-Tend interval
        F74 Flatness parameter, F73, normalized by the size of the QRS amplitude
        F75 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 90% of the Tstart-TCoM interval, and on the right side 90% of the TCoM-Tend interval
        F76 Flatness parameter, F75, normalized by the size of the QRS amplitude
        F77 Flatness evaluated in a asymmetric interval, which on the left side of CoM consist of, 100% of the Tstart-TCoM interval, and on the right side 100% of the TCoM-Tend interval
        F78 Flatness parameter, F77, normalized by the size of the QRS amplitude
        F79 Flatness evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to Tend, and Tend at 98% of the area.
        F80 Flatness parameter, F79, normalized by the size of the QRS amplitude
        F81 Flatness evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to Tend, and Tend at 95% of the area.
        F82 Flatness parameter, F81, normalized by the size of the QRS amplitude
        F83 Flatness evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to Tpeak, and Tend at 98% of the area from Tpeak to Tend.
        F84 Flatness parameter, F83, normalized by the size of the QRS amplitude
        F85 Flatness evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to Tpeak, and Tend at 95% of the area from Tpeak to Tend.
        F86 Flatness parameter, F85, normalized by the size of the QRS amplitude
        F87 Flatness evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to CoM, and Tend at 98% of the area from CoM to Tend.
        F88 Flatness parameter, F87, normalized by the size of the QRS amplitude
        F89 Flatness evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to CoM, and Tend at 95% of the area from CoM to Tend.
        F90 Flatness parameter, F89, normalized by the size of the QRS amplitude
        F91 Peakedness

Duration

        D1 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 10% of the Tstart-TPeak interval, and on the right side 10% of the TPeak-Tend interval
        D2 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 20% of the Tstart-TPeak interval, and on the right side 20% of the TPeak-Tend interval
        D3 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 30% of the Tstart-TPeak interval, and on the right side 30% of the TPeak-Tend interval
        D4 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 40% of the Tstart-TPeak interval, and on the right side 40% of the TPeak-Tend interval
        D5 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 50% of the Tstart-TPeak interval, and on the right side 50% of the TPeak-Tend interval
        D6 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 60% of the Tstart-TPeak interval, and on the right side 60% of the TPeak-Tend interval
        D7 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 70% of the Tstart-TPeak interval, and on the right side 70% of the TPeak-Tend interval
        D8 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 80% of the Tstart-TPeak interval, and on the right side 80% of the TPeak-Tend interval
        D9 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 90% of the Tstart-TPeak interval, and on the right side 90% of the TPeak-Tend interval
        D10 Variation evaluated in a asymmetric interval, which on the left side of Tpeak consist of, 100% of the Tstart-TPeak interval, and on the right side 100% of the TPeak-Tend interval
        D11 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 10% of the Tstart-TCoM interval, and on the right side 10% of the TCoM-Tend interval
        D12 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 20% of the Tstart-TCoM interval, and on the right side 20% of the TCoM-Tend interval
        D13 Variation evaluated in a asymmetric interval, which on the left side of TCoM consist of, 30% of the Tstart-TCoM interval, and on the right side 30% of the TCoM-Tend interval
        D14 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 40% of the Tstart-TCoM interval, and on the right side 40% of the TCoM-Tend interval
        D15 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 50% of the Tstart-TCoM interval, and on the right side 50% of the TCoM-Tend interval
        D16 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 60% of the Tstart-TCoM interval, and on the right side 60% of the TCoM-Tend interval
        D17 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 70% of the Tstart-TCoM interval, and on the right side 70% of the TCoM-Tend interval
        D18 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 80% of the Tstart-TCoM interval, and on the right side 80% of the TCoM-Tend interval
        D19 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 90% of the Tstart-TCoM interval, and on the right side 90% of the TCoM-Tend interval
        D20 Variation evaluated in a asymmetric interval, which on the left side of CoM consist of, 100% of the Tstart-TCoM interval, and on the right side 100% of the TCoM-Tend interval
        D21 Variation evaluated in a symmetric interval, 10% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D22 Variation evaluated in a symmetric interval, 20% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D23 Variation evaluated in a symmetric interval, 30% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D24 Variation evaluated in a symmetric interval, 40% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D25 Variation evaluated in a symmetric interval, 50% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D26 Variation evaluated in a symmetric interval, 60% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D27 Variation evaluated in a symmetric interval, 70% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D28 Variation evaluated in a symmetric interval, 80% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D29 Variation evaluated in a symmetric interval, 90% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D30 Variation evaluated in a symmetric interval, 100% of the Tstart-Tend interval, surrounding Tpeak with Tpeak as mean
        D31 Variation evaluated in a symmetric interval, 10% of the Tstart-Tend interval, surrounding CoM
        D32 Variation evaluated in a symmetric interval, 20% of the Tstart-Tend interval, surrounding CoM
        D33 Variation evaluated in a symmetric interval, 30% of the Tstart-Tend interval, surrounding CoM
        D34 Variation evaluated in a symmetric interval, 40% of the Tstart-Tend interval, surrounding CoM
        D35 Variation evaluated in a symmetric interval, 50% of the Tstart-Tend interval, surrounding CoM
        D36 Variation evaluated in a symmetric interval, 60% of the Tstart-Tend interval, surrounding CoM
        D37 Variation evaluated in a symmetric interval, 70% of the Tstart-Tend interval, surrounding CoM
        D38 Variation evaluated in a symmetric interval, 80% of the Tstart-Tend interval, surrounding CoM
        D39 Variation evaluated in a symmetric interval, 90% of the Tstart-Tend interval, surrounding CoM
        D40 Variation evaluated in a symmetric interval, 100% of the Tstart-Tend interval, surrounding CoM
        D41 Variation evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to Tend, and Tend at 98% of the area.
        D42 Variation evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to Tend, and Tend at 95% of the area.
        D43 Variation evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to Tpeak, and Tend at 98% of the area from Tpeak to Tend.
        D44 Variation evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to Tpeak, and Tend at 95% of the area from Tpeak to Tend.
        D45 Variation evaluated in a asymmetric interval, with Tstart at 2% of the area from the j-point to CoM, and Tend at 98% of the area from CoM to Tend.
        D46 Variation evaluated in a asymmetric interval, with Tstart at 5% of the area from the j-point to CoM, and Tend at 95% of the area from CoM to Tend.
        D47 Duration parameters, D1-D46, normalized by the size of the QRS amplitude

Complexity

        C1 Concavity upscore
        C2 Concavity parameter, C1, with concavity measure threshold Thrcm=0.1
        C3 Concavity parameter, C1, with concavity measure threshold Thrcm=0.15
        C4 Concavity parameter, C1, with concavity measure threshold Thrcm=0.2
        C5 Concavity parameter, C1, with certainty measure equal to LmRcurv
        C6 Concavity parameter, C1, with certainty measure
        C7 Concavity parameter, C1, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C8 Concavity parameter, C1, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C9 Concavity parameter, C1, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C10 Concavity parameter, C1, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C11 Concavity parameter, C1, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C12 Concavity parameter, C1, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C13 Concavity parameter, C1, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C14 Concavity parameter, C2 with certainty measure equal to LmRcurv
        C15 Concavity parameter, C3, with certainty measure equal to LmRcurv
        C16 Concavity parameter, C4, with certainty measure equal to LmRcurv
        C17 Concavity parameter, C2 with certainty measure
        C18 Concavity parameter, C3, with certainty measure C19 Concavity parameter, C4, with certainty measure
        C20 Concavity parameter, C2 with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C21 Concavity parameter, C2 with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C22 Concavity parameter, C3, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C23 Concavity parameter, C3, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C24 Concavity parameter, C4, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C25 Concavity parameter, C4, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C26 Concavity parameter, C5, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C27 Concavity parameter, C5, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C28 Concavity parameter, C6, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C29 Concavity parameter, C6, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C30 Concavity parameter, C2 with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C31 Concavity parameter, C2, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C32 Concavity parameter, C2, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C33 Concavity parameter, C2, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C34 Concavity parameter, C2, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C35 Concavity parameter, C3, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C36 Concavity parameter, C3, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C37 Concavity parameter, C3, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C38 Concavity parameter, C3, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C39 Concavity parameter, C3, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C40 Concavity parameter, C4, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C41 Concavity parameter, C4, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C42 Concavity parameter, C4, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C43 Concavity parameter, C4, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C44 Concavity parameter, C4, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C45 Concavity parameter, C5, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C46 Concavity parameter, C5, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C47 Concavity parameter, C5, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C48 Concavity parameter, C5, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C49 Concavity parameter, C5, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C50 Concavity parameter, C6, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C51 Concavity parameter, C6, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C52 Concavity parameter, C6, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C53 Concavity parameter, C6, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C54 Concavity parameter, C6, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C55 Concavity parameter, C7, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C56 Concavity parameter, C7, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C57 Concavity parameter, C7, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C58 Concavity parameter, C7, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C59 Concavity parameter, C7, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C60 Concavity parameter, C8, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C61 Concavity parameter, C8, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C62 Concavity parameter, C8, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C63 Concavity parameter, C8, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C64 Concavity parameter, C8, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C65 Concavity parameter, C14, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C66 Concavity parameter, C14, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C67 Concavity parameter, C14, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C68 Concavity parameter, C14, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C69 Concavity parameter, C14, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C70 Concavity parameter, C15, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C71 Concavity parameter, C15, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C72 Concavity parameter, C15, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C73 Concavity parameter, C15, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C74 Concavity parameter, C15, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C75 Concavity parameter, C16, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C76 Concavity parameter, C16, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C77 Concavity parameter, C16, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C78 Concavity parameter, C16, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C79 Concavity parameter, C16, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C80 Concavity parameter, C17, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C81 Concavity parameter, C17, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C82 Concavity parameter, C17, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C83 Concavity parameter, C17, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C84 Concavity parameter, C17, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C85 Concavity parameter, C18, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C86 Concavity parameter, C18, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C87 Concavity parameter, C18, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C88 Concavity parameter, C18, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C89 Concavity parameter, C18, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C90 Concavity parameter, C19, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C91 Concavity parameter, C19, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C92 Concavity parameter, C19, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C93 Concavity parameter, C19, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C94 Concavity parameter, C19, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C95 Concavity parameter, C20, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C96 Concavity parameter, C20, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C97 Concavity parameter, C20, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C98 Concavity parameter, C20, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C99 Concavity parameter, C20, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C100 Concavity parameter, C21, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C101 Concavity parameter, C21, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C102 Concavity parameter, C21, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C103 Concavity parameter, C21, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C104 Concavity parameter, C21, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C105 Concavity parameter, C22, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C106 Concavity parameter, C22, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C107 Concavity parameter, C22, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C108 Concavity parameter, C22, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C109 Concavity parameter, C22, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C110 Concavity parameter, C23, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C111 Concavity parameter, C23, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C112 Concavity parameter, C23, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C113 Concavity parameter, C23, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C114 Concavity parameter, C23, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C115 Concavity parameter, C24, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C116 Concavity parameter, C24, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C117 Concavity parameter, C24, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C118 Concavity parameter, C24, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C119 Concavity parameter, C24, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C120 Concavity parameter, C25, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C121 Concavity parameter, C25, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C122 Concavity parameter, C25, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C123 Concavity parameter, C25, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C124 Concavity parameter, C25, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C125 Concavity parameter, C26, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C126 Concavity parameter, C26, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C127 Concavity parameter, C26, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C128 Concavity parameter, C26, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C129 Concavity parameter, C26, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C130 Concavity parameter, C27, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C131 Concavity parameter, C27, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C132 Concavity parameter, C27, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C133 Concavity parameter, C27, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C134 Concavity parameter, C27, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C135 Concavity parameter, C28, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C136 Concavity parameter, C28, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C137 Concavity parameter, C28, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C138 Concavity parameter, C28, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C139 Concavity parameter, C28, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C140 Concavity parameter, C29, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C141 Concavity parameter, C29, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C142 Concavity parameter, C29, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C143 Concavity parameter, C29, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C144 Concavity parameter, C29, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C145 Concavity upscore with CuS=IuS
        C146 Concavity parameter, C145, with concavity measure threshold Thrcm=0.1
        C147 Concavity parameter, C145, with concavity measure threshold Thrcm=0.15
        C148 Concavity parameter, C145, with concavity measure threshold Thrcm=0.2
        C149 Concavity parameter, C145, with certainty measure equal to LmRcurv
        C150 Concavity parameter, C145, with certainty measure
        C151 Concavity parameter, C145, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C152 Concavity parameter, C145, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C153 Concavity parameter, C145, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C154 Concavity parameter, C145, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C155 Concavity parameter, C145, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C156 Concavity parameter, C145, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C157 Concavity parameter, C145, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C158 Concavity parameter, C146, with certainty measure equal to LmRcurv
        C159 Concavity parameter, C147, with certainty measure equal to LmRcurv
        C160 Concavity parameter, C148, with certainty measure equal to LmRcurv
        C161 Concavity parameter, C146, with certainty measure
        C162 Concavity parameter, C147, with certainty measure
        C163 Concavity parameter, C148, with certainty measure
        C164 Concavity parameter, C146, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C165 Concavity parameter, C146, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C166 Concavity parameter, C147, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C167 Concavity parameter, C147, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C168 Concavity parameter, C148, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C169 Concavity parameter, C148, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C170 Concavity parameter, C149, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C171 Concavity parameter, C149, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C172 Concavity parameter, C150, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C173 Concavity parameter, C150, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C174 Concavity parameter, C146, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C175 Concavity parameter, C146, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C176 Concavity parameter, C146, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C177 Concavity parameter, C146, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C178 Concavity parameter, C146, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C179 Concavity parameter, C147, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C180 Concavity parameter, C147, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C181 Concavity parameter, C147, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C182 Concavity parameter, C147, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C183 Concavity parameter, C147, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C184 Concavity parameter, C148, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C185 Concavity parameter, C148, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C186 Concavity parameter, C148, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C187 Concavity parameter, C148, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C188 Concavity parameter, C148, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C189 Concavity parameter, C149, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C190 Concavity parameter, C149, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C191 Concavity parameter, C149, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C192 Concavity parameter, C149, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C193 Concavity parameter, C149, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C194 Concavity parameter, C150, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C195 Concavity parameter, C150, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C196 Concavity parameter, C150, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C197 Concavity parameter, C150, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C198 Concavity parameter, C150, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C199 Concavity parameter, C151, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C200 Concavity parameter, C151, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C201 Concavity parameter, C151, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C202 Concavity parameter, C151, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C203 Concavity parameter, C151, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C204 Concavity parameter, C152, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C205 Concavity parameter, C152, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C206 Concavity parameter, C152, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C207 Concavity parameter, C152, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C208 Concavity parameter, C152, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C209 Concavity parameter, C158, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C210 Concavity parameter, C158, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C211 Concavity parameter, C158, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C212 Concavity parameter, C158, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C213 Concavity parameter, C158, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C214 Concavity parameter, C159, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C215 Concavity parameter, C159, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C216 Concavity parameter, C159, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C217 Concavity parameter, C159, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C218 Concavity parameter, C159, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C219 Concavity parameter, C160, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C220 Concavity parameter, C160, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C221 Concavity parameter, C160, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C222 Concavity parameter, C160, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C223 Concavity parameter, C160, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C224 Concavity parameter, C161, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C225 Concavity parameter, C161, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C226 Concavity parameter, C161, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C227 Concavity parameter, C161, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C228 Concavity parameter, C161, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C229 Concavity parameter, C162, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C230 Concavity parameter, C162, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C231 Concavity parameter, C162, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C232 Concavity parameter, C162, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C233 Concavity parameter, C162, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C234 Concavity parameter, C163, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C235 Concavity parameter, C163, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C236 Concavity parameter, C163, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C237 Concavity parameter, C163, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C238 Concavity parameter, C163 with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C239 Concavity parameter, C164, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C240 Concavity parameter, C164, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C241 Concavity parameter, C164, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C242 Concavity parameter, C164, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C243 Concavity parameter, C164, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C244 Concavity parameter, C165, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C245 Concavity parameter, C165, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C246 Concavity parameter, C165, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C247 Concavity parameter, C165, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C248 Concavity parameter, C165, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C249 Concavity parameter, C166, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C250 Concavity parameter, C166, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C251 Concavity parameter, C166, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C252 Concavity parameter, C166, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C253 Concavity parameter, C166, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C254 Concavity parameter, C167, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C255 Concavity parameter, C167, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C256 Concavity parameter, C167, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C257 Concavity parameter, C167, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C258 Concavity parameter, C167, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C259 Concavity parameter, C168, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C260 Concavity parameter, C168, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C261 Concavity parameter, C168, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C262 Concavity parameter, C168, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C263 Concavity parameter, C168, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C264 Concavity parameter, C169, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C265 Concavity parameter, C169, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C266 Concavity parameter, C169, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C267 Concavity parameter, C169, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C268 Concavity parameter, C169, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C269 Concavity parameter, C170, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C270 Concavity parameter, C170, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C271 Concavity parameter, C170, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C272 Concavity parameter, C170, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C273 Concavity parameter, C170, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C274 Concavity parameter, C171, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C275 Concavity parameter, C171, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C276 Concavity parameter, C171, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C277 Concavity parameter, C171, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C278 Concavity parameter, C171, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C279 Concavity parameter, C172, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C280 Concavity parameter, C172, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C281 Concavity parameter, C172, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C282 Concavity parameter, C172, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C283 Concavity parameter, C172, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C284 Concavity parameter, C173, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C285 Concavity parameter, C173, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C286 Concavity parameter, C173, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C287 Concavity parameter, C173, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C288 Concavity parameter, C173, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C289 Concavity downscore
        C290 Concavity parameter, C289, with concavity measure threshold Thrcm=0.1
        C291 Concavity parameter, C289, with concavity measure threshold Thrcm=0.15
        C292 Concavity parameter, C289, with concavity measure threshold Thrcm=0.2
        C293 Concavity parameter, C289, with certainty measure equal to LmRcurv
        C294 Concavity parameter, C289, with certainty measure
        C295 Concavity parameter, C289, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C296 Concavity parameter, C289, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C297 Concavity parameter, C289, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C298 Concavity parameter, C289, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C299 Concavity parameter, C289, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C300 Concavity parameter, C289, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C301 Concavity parameter, C289, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C302 Concavity parameter, C290, with certainty measure equal to LmRcurv
        C303 Concavity parameter, C291, with certainty measure equal to LmRcurv
        C304 Concavity parameter, C292, with certainty measure equal to LmRcurv
        C305 Concavity parameter, C290, with certainty measure
        C306 Concavity parameter, C291, with certainty measure
        C307 Concavity parameter, C292, with certainty measure
        C308 Concavity parameter, C290, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C309 Concavity parameter, C290, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C310 Concavity parameter, C291, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C311 Concavity parameter, C291, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C312 Concavity parameter, C292, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C313 Concavity parameter, C292, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C314 Concavity parameter, C293, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C315 Concavity parameter, C293, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C316 Concavity parameter, C294, with 30 ms LmRcurv exclusion window, symmetric around Tpeak
        C317 Concavity parameter, C294, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C318 Concavity parameter, C290 with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C319 Concavity parameter, C290 with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C320 Concavity parameter, C290 with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C321 Concavity parameter, C290 with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C322 Concavity parameter, C290 with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C323 Concavity parameter, C291, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C324 Concavity parameter, C291, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C325 Concavity parameter, C291, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C326 Concavity parameter, C291, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C327 Concavity parameter, C291, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C328 Concavity parameter, C292, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C329 Concavity parameter, C292, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C330 Concavity parameter, C292, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C331 Concavity parameter, C292, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C332 Concavity parameter, C292, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C333 Concavity parameter, C293, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C334 Concavity parameter, C293, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C335 Concavity parameter, C293, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C336 Concavity parameter, C293, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C337 Concavity parameter, C293, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C338 Concavity parameter, C294, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C339 Concavity parameter, C294, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C340 Concavity parameter, C294, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C341 Concavity parameter, C294, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C342 Concavity parameter, C294, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C343 Concavity parameter, C295, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C344 Concavity parameter, C295, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C345 Concavity parameter, C295, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C346 Concavity parameter, C295, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C347 Concavity parameter, C295, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C348 Concavity parameter, C296, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C349 Concavity parameter, C296, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C350 Concavity parameter, C296, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C351 Concavity parameter, C296, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C352 Concavity parameter, C296, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C353 Concavity parameter, C302, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C354 Concavity parameter, C302, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C355 Concavity parameter, C302, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C356 Concavity parameter, C302, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C357 Concavity parameter, C302, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C358 Concavity parameter, C303, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C359 Concavity parameter, C303, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C360 Concavity parameter, C303, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C361 Concavity parameter, C303, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C362 Concavity parameter, C303, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C363 Concavity parameter, C304, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C364 Concavity parameter, C304, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C365 Concavity parameter, C304, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C366 Concavity parameter, C304, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C367 Concavity parameter, C304, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C368 Concavity parameter, C305, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C369 Concavity parameter, C305, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C370 Concavity parameter, C305, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C371 Concavity parameter, C305, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C372 Concavity parameter, C305, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C373 Concavity parameter, C306, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C374 Concavity parameter, C306, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C375 Concavity parameter, C306, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C376 Concavity parameter, C306, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C377 Concavity parameter, C306, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C378 Concavity parameter, C307, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C379 Concavity parameter, C307, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C380 Concavity parameter, C307, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C381 Concavity parameter, C307, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C382 Concavity parameter, C307, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C383 Concavity parameter, C308, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C384 Concavity parameter, C308, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C385 Concavity parameter, C308, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C386 Concavity parameter, C308, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C387 Concavity parameter, C308, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C388 Concavity parameter, C309, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C389 Concavity parameter, C309, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C390 Concavity parameter, C309, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C391 Concavity parameter, C309, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C392 Concavity parameter, C309, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C393 Concavity parameter, C310, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C394 Concavity parameter, C310, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C395 Concavity parameter, C310, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C396 Concavity parameter, C310, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C397 Concavity parameter, C310, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C398 Concavity parameter, C311, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C399 Concavity parameter, C311, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C400 Concavity parameter, C311, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C401 Concavity parameter, C311, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C402 Concavity parameter, C311, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C403 Concavity parameter, C312, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C404 Concavity parameter, C312, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C405 Concavity parameter, C312, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C406 Concavity parameter, C312, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C407 Concavity parameter, C312, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C408 Concavity parameter, C313, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C409 Concavity parameter, C313, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C410 Concavity parameter, C313, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C411 Concavity parameter, C313, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C412 Concavity parameter, C313, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C413 Concavity parameter, C314, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C414 Concavity parameter, C314, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C415 Concavity parameter, C314, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C416 Concavity parameter, C314 with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C417 Concavity parameter, C314, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C418 Concavity parameter, C315, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C419 Concavity parameter, C315, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C420 Concavity parameter, C315, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C421 Concavity parameter, C315, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C422 Concavity parameter, C315, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C423 Concavity parameter, C316, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C424 Concavity parameter, C316, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C425 Concavity parameter, C316, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C426 Concavity parameter, C316, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C427 Concavity parameter, C316, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C428 Concavity parameter, C317, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C429 Concavity parameter, C317, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C430 Concavity parameter, C317, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C431 Concavity parameter, C317, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C432 Concavity parameter, C317, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C433 Concavity parameter, C17 with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C434 Concavity parameter, C18 with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C435 Concavity parameter, C19 with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C436 Concavity parameter, C433, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C437 Concavity parameter, C433, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C438 Concavity parameter, C433, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C439 Concavity parameter, C433, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C440 Concavity parameter, C433, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C441 Concavity parameter, C434, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C442 Concavity parameter, C434, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C443 Concavity parameter, C434, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C444 Concavity parameter, C434, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C445 Concavity parameter, C434, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C446 Concavity parameter, C435, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C447 Concavity parameter, C435, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C448 Concavity parameter, C435, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C449 Concavity parameter, C435, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C450 Concavity parameter, C435, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C451 Concavity parameter, C161, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C452 Concavity parameter, C162, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C453 Concavity parameter, C163, with 20 ms LmRcurv exclusion window, symmetric around Tpeak
        C454 Concavity parameter, C451, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C455 Concavity parameter, C451, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C456 Concavity parameter, C451, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C457 Concavity parameter, C451, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C458 Concavity parameter, C451, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C459 Concavity parameter, C452, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C460 Concavity parameter, C452, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C461 Concavity parameter, C452, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C462 Concavity parameter, C452, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C463 Concavity parameter, C452, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded
        C464 Concavity parameter, C453, with LmRcurv points that correspond in time to ECG amplitude below 20% excluded
        C465 Concavity parameter, C453, with LmRcurv points that correspond in time to ECG amplitude below 30% excluded
        C466 Concavity parameter, C453, with LmRcurv points that correspond in time to ECG amplitude below 40% excluded
        C467 Concavity parameter, C453, with LmRcurv points that correspond in time to ECG amplitude below 50% excluded
        C468 Concavity parameter, C453, with LmRcurv points that correspond in time to ECG amplitude below 60% excluded

## Claims

1. System for analysis of ECG curvature comprising a computer system, which computer system performs a mathematical analysis, which mathematical analysis comprises at least the following steps:
a: the system comprises input means connected to at least one ECG source,
b: a number of different parameters are isolated and stored in the computer system,
c: the computer system select a first number of parameters from at least one main group,
d: the computer system combine the selected parameters in at least a first mathematical analysis, whereby the parameters are selected from groups of symmetry (S1-S72), flatness (F1-F91), duration (D1-D47) and/or complexity (C1-C468),
e: extract a segment in of the ECG curvature in the mathematical analysis,
f: which segment is corresponding to a interval between defined electrocardiographic points,
g: which segment is used as input to a first algorithm,
h: where a second fiducial point algorithm automatically calculates fiducial points at the segment,
i: where concavity intervals are evaluated on subsegments of the ECG segment and form the basis of up- and downwards concavity quantification,
j: where the system based on at least the first and the second algorithm detects and quantifies concavity on ECG curvatures;
wherein at least one segment of the ECG repolarization signal is selected, corresponding to the interval between the Twave onset and Twave offset, which segment is normalized so that the amplitude range (y) is equal to a first predefined value in the selected interval.

2. A system according to claim 1, wherein at least one segment of the ECG repolarization signal is selected, corresponding to the interval between the Twave onset and Twave offset, which segment is normalized so that the duration (x) is equal to a second predefined value in the selected interval.

3. A system according to one of the claim 2, wherein the first and second derivatives (with respect to time) of the ECG repolarization segment are determined on the interval between the Twave onset and Twave offset, where the two derivative signals are subsequently used to calculate a radius of curvature (Rcurv) signal using the equation 1:




  
    
      
        Rcurv
        =
        
          -
          
            
              
                [
                
                  1
                  +
                  
                    
                      (
                      
                        
                          d
                          y
                        
                        
                          d
                          x
                        
                      
                      )
                    
                    2
                  
                
                ]
              
              
                3
                /
                2
              
            
            
              
                
                  d
                  2
                
                ⁢
                y
              
              
                d
                
                  x
                  2
                
              
            
          
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        1
      
    
  




where x is the timescale and y is the (ECG) signal.

4. A system according to claim 3, wherein local maxima (LmRcurv) on the Rcurv signal between any two repolarization fiducial points is determined to identify places of local downwards concavity on a repolarization segment of an ECG.

5. A system according to claim 4, wherein local minima on the Rcurv signal between any two repolarization fiducial points are determined to identify places of local upwards concavity on a repolarization segment of an ECG.

6. A system according to claim 5, wherein the Rcurv signal is investigated further to identify any contiguous configuration of local maximum neighbored by local minimum on the Rcury signal, where the values of the identified maximum and minimum are used to evaluate the size of any concavity on a repolarization segment of an ECG.

7. A system according to claim 3, wherein a window is defined in a curve segment stating at a first defined period before Twave peak and ending at a second defined period after Twave peak, in which window the curvature is excluded from further analysis of the Rcurv signal, and where any number of LmRcurv signal values with amplitudes below zero is excluded from further analysis, where any number of LmRcurv signal values, which correspond in time to ECG repolarization amplitudes below any given threshold are excluded from further analysis.

8. A system according to claim 3, wherein positive segment durations on the Rcurv on either side of all reference points are multiplied by the value of the corresponding LmRcurv values to obtain certainty measures (Cm) of the presence of local downward concavities.

9. A system according to claim 8, wherein certainty measures exceeding a threshold (Thr) are defined as places around which concavity intervals are defined and local downward concavities are quantified.

10. A system according to claim 9, wherein no certainty measures exceeding a threshold (Thr) are present, where a first subsegment is generated by two piecewise tilted segments, where a first tilted subsegment (T1tilt) is given by the repolarization interval between the Twave onset and Twave peak from which the linear function between the two endpoints is subtracted, where a second tilted subsegment (T2tilt) is given by the repolarization interval between the Twave peak and Twave offset from which the linear function between the two endpoints is subtracted.

11. A system according to claim 10, wherein an upwards concavity score is calculated, where the least negative minimum on either piecewise repolarization subsegment is used as an initial upwards concavity score (IuS), which score is corrected to obtain a final upwards concavity score (CuS), where the relationship is given by equation 3:




  
    
      
        CuS
        =
        
          
            IuS
            ⁡
            
              (
              
                1
                -
                
                  Cm
                  Thr
                
              
              )
            
          
          .
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        3

12. A system according to claim 9, wherein certainty measures exceeding a threshold (Thr) are present, where at least one third subsegment is generated by piecewise tilted segments in concavity intervals, from which the linear function between the two endpoints in concavity intervals is subtracted.

13. A system according to claim 12, wherein all of the tilted subsegments (N) are evaluated and maximum values (T3tiltmax) to (TNtiltmax) on the tilted subsegments in the concavity intervals are determined, where the overall maximum value is the final concave down score (CdS) of the ECG repolarization segment given by equation 2:


CdS=max({T3tiltmax . . . TNtiltmax}  Equation 2.

14. A system according to claim 1, wherein the peakedness of the T wave peak (Peak_Curvature) is evaluated by calculating the radius of curvature value (Rcurv) in Tpeak, which radius of curvature is given by:




  Rcurv
  =
  
    -
    
      
        
          [
          
            1
            +
            
              
                (
                
                  
                    d
                    y
                  
                  
                    d
                    x
                  
                
                )
              
              2
            
          
          ]
        
        
          3
          /
          2
        
      
      
        
          
            d
            2
          
          ⁢
          y
        
        
          d
          
            x
            2
          
        
      
    
  




where x is the timescale normalized with the T wave width, and y is the ECG signal normalized with the T wave amplitude.

15. A system according to claim 1, wherein the symmetric properties of the T wave are evaluated by comparing the T wave curve on the right side of Tpeak with the T wave curve on the left side of Tpeak, which comparison of left and right side is performed at any representation of the T wave, such as the time domain ECG signal, the first derivative of the signal, the second derivative of the signal or any combination of these such as the radius of curvature of the signal Rcurv.

16. A system according to claim 15, wherein the Twave representation of the right side of Tpeak is flipped around a vertical line through Tpeak to cover the left side of Tpeak.

17. A system according to claim 16, wherein a first or second derivative is used for the mathematical analysis, where the Twave representation of the right side of Tpeak is flipped around the x axis to compensate for the sign difference between the two sides.

18. A system according to claim 1, wherein the system analyzes ECG curvature for drug influence.

19. A system for analysing ECG curvature according to claim 1, wherein the system analyzes ECG curvature for Long QT Syndrome.