心电图中性别的差异的解剖基础通过三维躯体-心脏成像重建流程确定
Anatomical basis of sex differences in the electrocardiogram identified by three-dimensional torso-heart imaging reconstruction pipeline
AI总结：
本研究通过三维躯体-心脏成像重建流程，揭示了性别差异在心电图特征和解剖结构中的关系，强调了量化性别差异对心电图解读和临床应用的重要性。
摘要：
心电图（ECG）用于心肌梗死（MI）的诊断和风险分层。女性有更高的MI诊断遗漏率和梗死后的并发症发生率，为此我们旨在提供关于ECG和躯体-心室解剖特征及其相互依赖性的定量信息。本文介绍了一种新的计算自动化流程，能够从英国生物库临床图像中对425名MI后患者和1051名健康对照者进行三维躯体-心室解剖重建。建立了将躯体-心室和ECG参数联系起来的回归模型。我们发现，女性的心脏位置比男性更靠后和更高，在MI心脏中，女性的心脏更水平。MI后女性表现出更少的QRS延长，需要比男性多27%的延长才能超过120ms。只有半数的性别差异与较小的女性心腔有关。女性的STj振幅较低，这与较小的心室有关，但同时也与更靠上和靠后的心脏位置有关。MI后，女性的T波振幅和R轴偏移与后置和水平心脏位置的关联性更强。我们的研究强调了量化性别差异在解剖特征中的重要性，其在ECG解释中的影响，以及在MI后应用临床ECG阈值的必要性。
英文摘要：
The electrocardiogram (ECG) is used for diagnosis and risk stratification in myocardial infarction (MI). Women have a higher incidence of missed MI diagnosis and complications following infarction, and to address this we aim to provide quantitative information on sex-differences in ECG and torso-ventricular anatomical features and their interdependence. A novel computational automated pipeline is presented enabling the three-dimensional reconstruction of torso-ventricular anatomies for 425 post-MI subjects and 1051 healthy controls from UK Biobank clinical images. Regression models were created relating torso-ventricular and ECG parameters. We found that female hearts were positioned more posteriorly and superiorly than male, and in MI hearts were oriented more horizontally, especially for women. Post-MI women exhibited less QRS prolongation, requiring 27% more prolongation than men to exceed 120ms. Only half of the sex difference in QRS duration was associated with smaller female cavities. Lower STj amplitude in women was striking, associated with smaller ventricles, but also more superior and posterior cardiac position. Post-MI, T wave amplitude and R axis deviations were more strongly associated with posterior and horizontal cardiac positioning in women than in men. Our study highlights the need to quantify sex differences in anatomical features, their implications in ECG interpretation, and the application of clinical ECG thresholds in post-MI.
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