Electrocardiogram Standards for Children and Young Adults Using Z -Scores

Abstract

<jats:p> <jats:bold>Background</jats:bold> - Normative ECG values for children are based on relatively few subjects and are not standardized, resulting in interpersonal variability of interpretation. Recent advances in digital technology allow a more quantitative, reproducible assessment of ECG variables. Our objective was to create the foundation of normative ECG standards in the young utilizing Z-scores. </jats:p> <jats:p> <jats:bold>Methods</jats:bold> - One-hundred-and-two ECG variables were collected from a retrospective cohort of 27085 study subjects with no known heart condition, ages 0-39 years. The cohort was divided into 16 age groups by gender. Median, interquartile range and range were calculated for each variable adjusted to body surface area. </jats:p> <jats:p> <jats:bold>Results</jats:bold> - Normative standards were developed for all 102 ECG variables including heart rate; P, R, and T axis; R-T axis deviation; PR interval, QRS duration, QT and QTc interval; P, Q, R, S, and T amplitudes in 12 leads; as well as QRS and T wave integrals. Incremental Z-score values between -2.5 and 2.5 were calculated to establish upper and lower limits of normal. Historical ECG interpretative concepts were reassessed and new concepts observed. </jats:p> <jats:p> <jats:bold>Conclusions</jats:bold> - Electronically acquired ECG values based on the largest pediatric and young adult cohort ever compiled provide the first detailed, standardized, quantitative foundation of traditional and novel ECG variables. Expression of ECG variables by Z-scores lends an objective and reproducible evaluation without interpreter bias that can lead to more confident establishment of ECG-disease correlations and improved automated ECG readings in high volume cardiac screening efforts in the young. </jats:p>

Change in suicidal ideation and associated factors among young adults in Hong Kong from 2018 to 2019: a latent transition analysis

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Neonatal Myocardial Infarction: A Proposed Algorithm for Coronary Arterial Thrombus Management

“…Low-amplitude R waves were seen across the precordial leads from V 4 through V 6 . Published normal subject data 5 for the Z scores for R amplitude in these leads for these patients ranged from −1.7 to −2.0. Subjects were subdivided into ischemic and infarction pattern groups based solely on foundational ECG reading principles, that is, ST-segment abnormalities versus the presence of abnormal Q waves.…”

“…Regional wall motion abnormality was noted in all 21 patients with varying degrees of depressed LV function (severe [8], moderate [6], mild [2], and low normal [5]). LV ejection fraction ranged from 20% to 54% (median, 43% [IQR, 34%-51%]).…”

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes

“…Age and sex-related differences are summarized from the observation that from birth through adolescence, principal modifications are related to decreasing heart rate, increasing QRS voltages, and a widening QRS complex. These data have been provided for the non-athlete pediatric population (14). In this study, we have sought to provide reference values for normal ECG parameters in a population of more than 2,000 junior athletes evaluated with ECG and echocardiography, which constitute a unique study population of healthy athletes.…”