Background
Methods
Study population
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There was interference, artifacts or electrode placement errors (Minnesota Code [MC] 9.8.1 or 9.8.2);
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The ECG had an established abnormality: old myocardial infarction (major Q wave abnormalities [MC 1.1.x or 1.2.x]), possible old myocardial infarction (minor Q wave abnormalities plus ST-T abnormalities [MC 1.3 plus 4.1, 4.2, 5.1 or 5.2]), major isolated ST-T abnormalities (MC 4.1, 4.2, 5.1 or 5.2) complete or intermittent intraventricular blocks (MC 7.1, 7.2, 7.4 or 7.8), left ventricular hypertrophy plus ST-T abnormalities (MC 3.1 plus 4.1.x, 4.2, 5.1 or 5.2), major prolonged uncorrected QT interval (QTi ≥ 116%), major atrioventricular conduction abnormalities (MC 6.1, 6.2.x, 6.4, 6.8, 8.6.1 or 8.6.2), atrial fibrillation or flutter (MC 8–3-x), supraventricular tachycardia (MC 8.4.2 or 8–4-1 with heart rate > 140 bpm), wandering atrial pacemaker (MC 8.1.4), supraventricular rhythm persistent (MC 8.4.1 plus heart rate ≤ 140), high amplitude P wave (MC 9.3), asystole or ventricular fibrillation (MC 8.2);
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Repeated exams: for the purpose of this analysis, only the first ECG from patients with multiple ECGs was analyzed.
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Patient had these self-declared comorbidities or cardiovascular risk factors: arterial hypertension, diabetes, smoking, dyslipidemia, personal history of myocardial infarction, personal history of coronary revascularization, Chagas disease and chronic pulmonary disease;
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Patient was receiving any kind of drug therapy (diuretics, digitalis, beta-blockers, angiotensin-converting-enzyme inhibitors, amiodarone, calcium channel blockers or any drug listed in the “others” field).
Data acquisition
Database
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patient identification: full name, gender, birth date and city of domicile;
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comorbidities and cardiovascular risk factors: arterial hypertension, obesity, diabetes, smoking, dyslipidemia, personal history of myocardial infarction, personal history of coronary revascularization, family history of coronary disease, Chagas disease and chronic pulmonary disease;
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medications: diuretics, digitalis, beta-blockers, angiotensin-converting-enzyme inhibitors, amiodarone and calcium channel blockers) or free text field (“others”);
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symptoms: chest pain and any equivalent;
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anthropometric measures: height and weight;
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12 lead ECG recordings;
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administrative information about the ECG: date and city in which it was performed.
The Glasgow program
Comparison with other studies
Study | Population | Year | Patients (n) | ECG acquisition | Sampling rate | Analytic program | Percentiles |
---|---|---|---|---|---|---|---|
Rijnbeek et al. | 0 to 16 y; Dutch | 2001 | Male (944); Female (968) | Cardio Control (Delft, Netherlands) | 1200 Hz | MEANSa
| 2nd, 50th and 98th |
Wu et al. | 18 to ≥ 60 y; Chinesese | 2003 | Male (3614); Female (1746) | Cardio Control (Delft, Netherlands) | 1200 Hz | MEANSa
| 2nd, 50th and 98th |
Mason et al. | 0 to 99 years; Northern America (70%), Europe (21%), Africa (3%), Latin America (3%), and Asia (2%) and Oceania (2%). | 2007 | Male (14,297); Female (12,201) | MTX-2 (CCSSI); MAC 1200 (GE Medical Systems) | 500 Hz | CCSSI | 1st, 2nd, 50th, 98th, 99th |
Rijnbeek et al. | 16 to 89 y; Dutch | 2014 | Male (7326); Female (6028) | ACTA (ESAOTE, Florence, Italy); Cardio Perfect equipment (Welch Allyn Cardio Control, USA); Megacart (Siemens, Erlangen, Germany) | 500 Hz | MEANSa
| 2nd, 50th and 98th |
Statistical analysis and estimation of normal values
Results
Characteristics of the study population
Age group (years) | Male | Female | Total | |
---|---|---|---|---|
n | n | n | % | |
1–2 | 259 | 216 | 475 | 0.1% |
3–4 | 840 | 667 | 1507 | 0.3% |
5–7 | 2486 | 1947 | 4433 | 0.9% |
8–11 | 6802 | 4601 | 11,403 | 2.4% |
12–15 | 11,812 | 10,709 | 22,521 | 4.6% |
16–19 | 11,295 | 14,453 | 25,748 | 5.3% |
20–29 | 26,063 | 43,281 | 69,344 | 14.3% |
30–39 | 31,138 | 55,671 | 86,809 | 17.9% |
40–49 | 34,414 | 57,942 | 92,356 | 19.0% |
50–59 | 32,988 | 46,563 | 79,551 | 16.4% |
60–69 | 24,149 | 28,620 | 52,769 | 10.9% |
70–79 | 13,499 | 15,280 | 28,779 | 5.9% |
80–89 | 4120 | 4998 | 9118 | 1.9% |
> = 90 | 482 | 719 | 1201 | 0.2% |
Total | 200,347 | 285,667 | 486,014 | 100% |
Electrocardiographic findings
Global measurements
Parameter | Sex | 1–2 | 3–4 | 5–7 | 8–11 | 12–15 | 16–19 | 20–29 |
---|---|---|---|---|---|---|---|---|
Heart rate (bpm) | Male | (52; 59; 107; 166; 170) | (67; 70; 97; 132; 139) | (59; 61; 86; 120; 126) | (53; 55; 76; 108; 114) | (47; 49; 69; 101; 107) | (44; 46; 65; 98; 105) | (44; 46; 65; 98; 104) |
Female | (58; 66; 108; 163; 199) | (64; 69; 98; 138; 141) | (62; 64; 88; 124; 133) | (56; 58; 81; 115; 121) | (52; 54; 75; 107; 114) | (51; 53; 73; 105; 112) | (51; 53; 73; 104; 111) | |
P Frontal Axis (°) | Male | (−95; −10; 53; 85; 116) | (−30; −14; 50; 79; 96) | (−34; −22; 44; 74; 81) | (−35; −21; 41; 74; 79) | (−33; −20; 44; 77; 82) | (−32; −21; 54; 81; 85) | (−22; −13; 54; 80; 85) |
Female | (−12; −6; 53; 78; 85) | (−30; −10; 51; 76; 90) | (−19; −11; 49; 74; 83) | (−21; −12; 45; 74; 78) | (−21; −13; 48; 76; 80) | (−22; −13; 51; 77; 82) | (−18; −11; 51; 78; 81) | |
QRS Frontal Axis (°) | Male | (−46; −26; 61; 124; 132) | (−21; −9; 61; 99; 111) | (−29; −10; 64; 101; 111) | (−31; −8; 64; 99; 107) | (−28; −11; 66; 101; 107) | (−41; −18; 68; 100; 107) | (−37; −20; 59; 96; 101) |
Female | (−49; −20; 62; 102; 136) | (−22; −3; 66; 102; 108) | (−9; 0; 67; 100; 109) | (−14; 0; 66; 98; 104) | (−8; 2; 65; 95; 100) | (−13; 0; 63; 95; 99) | (−16; −5; 56; 89; 95) | |
T Frontal Axis (°) | Male | (−9; 2; 43; 70; 73) | (5; 9; 43; 65; 69) | (7; 13; 45; 67; 70) | (7; 12; 46; 68; 71) | (2; 9; 48; 71; 73) | (−3; 3; 47; 72; 75) | (−12; −5; 40; 71; 75) |
Female | (8; 12; 43; 73; 77) | (−4; 0; 42; 68; 70) | (4; 9; 44; 68; 71) | (1; 8; 45; 69; 72) | (0; 4; 44; 69; 73) | (−2; 3; 42; 70; 73) | (−7; −1; 38; 68; 72) | |
Overall P Duration (ms) | Male | (63; 64; 84; 124; 142) | (64; 70; 86; 112; 124) | (64; 68; 88; 114; 128) | (68; 72; 94; 118; 132) | (68; 72; 98; 124; 134) | (68; 74; 102; 126; 134) | (72; 78; 106; 132; 138) |
Female | (52; 63; 84; 115; 128) | (64; 68; 86; 115; 127) | (68; 72; 90; 116; 128) | (70; 72; 94; 116; 130) | (72; 76; 98; 124; 132) | (72; 78; 100; 128; 134) | (74; 78; 104; 132; 138) | |
Overall PR Interval (ms) | Male | (81; 86; 118; 184; 192) | (90; 92; 122; 170; 186) | (90; 94; 124; 174; 188) | (96; 100; 132; 180; 190) | (98; 104; 136; 188; 202) | (102; 106; 142; 196; 206) | (104; 110; 148; 200; 212) |
Female | (84; 87; 118; 171; 178) | (88; 90; 120; 166; 171) | (90; 94; 124; 166; 173) | (94; 98; 128; 178; 188) | (98; 102; 136; 184; 196) | (98; 104; 138; 188; 198) | (102; 106; 142; 192; 202) | |
Overall QRS Duration (ms) | Male | (60; 62; 74; 98; 101) | (64; 66; 76; 92; 96) | (66; 66; 80; 99; 102) | (68; 70; 84; 102; 106) | (72; 74; 90; 108; 112) | (74; 76; 94; 114; 116) | (76; 78; 96; 114; 116) |
Female | (58; 60; 72; 97; 100) | (62; 62; 74; 90; 94) | (62; 64; 78; 96; 98) | (66; 68; 80; 98; 100) | (68; 70; 84; 102; 106) | (70; 70; 86; 104; 108) | (70; 72; 88; 106; 110) | |
QT Interval (ms) | Male | (239; 250; 314; 412; 426) | (276; 281; 332; 396; 405) | (294; 300; 356; 412; 423) | (314; 322; 378; 436; 446) | (324; 332; 390; 452; 460) | (320; 328; 390; 454; 462) | (324; 332; 390; 456; 464) |
Female | (224; 255; 314; 419; 454) | (271; 278; 332; 396; 412) | (286; 296; 350; 402; 408) | (306; 314; 368; 426; 434) | (314; 322; 380; 440; 450) | (316; 326; 382; 442; 450) | (320; 328; 386; 446; 454) | |
QTc Hodges (ms) | Male | (367; 370; 405; 444; 455) | (364; 369; 399; 430; 437) | (370; 375; 403; 436; 441) | (374; 377; 408; 440; 445) | (370; 374; 408; 446; 452) | (364; 368; 400; 442; 450) | (365; 368; 400; 442; 449) |
Female | (363; 367; 404; 459; 470) | (369; 371; 401; 436; 440) | (371; 375; 403; 431; 437) | (373; 378; 407; 438; 442) | (375; 379; 409; 443; 449) | (373; 377; 408; 443; 449) | (375; 379; 411; 447; 452) | |
QTc Bazett (ms) | Male | (377; 384; 421; 459; 469) | (377; 384; 421; 460; 467) | (381; 388; 425; 463; 469) | (381; 386; 425; 463; 469) | (368; 374; 419; 462; 468) | (358; 364; 406; 452; 458) | (359; 364; 406; 451; 459) |
Female | (380; 383; 421; 467; 479) | (382; 388; 424; 464; 470) | (385; 390; 425; 461; 467) | (384; 389; 427; 465; 471) | (382; 387; 426; 466; 471) | (377; 383; 423; 463; 469) | (379; 385; 426; 466; 471) | |
QTc Fridericia (ms) | Male | (332; 342; 381; 429; 434) | (349; 358; 389; 427; 432) | (361; 367; 400; 439; 443) | (371; 376; 408; 442; 447) | (368; 372; 408; 447; 453) | (362; 366; 400; 441; 448) | (363; 367; 400; 439; 446) |
Female | (332; 339; 383; 445; 453) | (354; 358; 391; 431; 438) | (361; 366; 398; 433; 436) | (369; 374; 406; 440; 444) | (372; 377; 410; 446; 451) | (371; 375; 408; 444; 450) | (374; 378; 411; 448; 454) | |
QTc Framingham (ms) | Male | (336; 344; 382; 429; 435) | (355; 361; 390; 426; 430) | (364; 371; 401; 436; 441) | (374; 378; 409; 442; 446) | (368; 373; 409; 446; 452) | (359; 365; 400; 440; 447) | (361; 365; 400; 438; 444) |
Female | (332; 345; 382; 441; 448) | (358; 359; 390; 428; 435) | (363; 369; 399; 430; 434) | (372; 376; 406; 439; 444) | (375; 379; 410; 444; 450) | (373; 377; 409; 444; 449) | (375; 380; 412; 447; 453) |
Parameter | Sex | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | 80–89 | > = 90 |
---|---|---|---|---|---|---|---|---|
Heart rate (bpm) | Male | (44; 46; 65; 99; 105) | (44; 46; 66; 98; 104) | (44; 46; 66; 98; 104) | (44; 46; 66; 99; 104) | (45; 47; 66; 99; 105) | (45; 47; 68; 104; 111) | (47; 49; 70; 109; 118) |
Female | (50; 52; 72; 102; 107) | (49; 52; 71; 101; 107) | (48; 50; 70; 99; 105) | (48; 50; 70; 101; 106) | (48; 50; 71; 102; 106) | (48; 51; 73; 105; 111) | (50; 52; 76; 111; 120) | |
P Frontal Axis (°) | Male | (−15; −8; 53; 80; 85) | (−13; −5; 55; 80; 85) | (−12; −3; 57; 82; 87) | (−11; −3; 58; 84; 93) | (−12; −5; 60; 86; 95) | (−25; −9; 61; 94; 103) | (−35; −23; 61; 95; 101) |
Female | (−15; −8; 52; 78; 82) | (−13; −5; 53; 79; 83) | (−12; −4; 53; 79; 83) | (−12; −5; 54; 80; 85) | (−13; −5; 57; 84; 94) | (−15; −7; 58; 85; 97) | (−45; −13; 59; 85; 99) | |
QRS Frontal Axis (°) | Male | (−41; −28; 47; 90; 96) | (−48; −36; 38; 85; 91) | (−56; −45; 31; 82; 85) | (−61; −51; 23; 80; 84) | (−65; −57; 18; 79; 84) | (−70; −62; 15; 78; 83) | (−69; −62; 15; 84; 98) |
Female | (−24; −14; 46; 84; 87) | (−32; −23; 37; 80; 85) | (−41; −33; 28; 77; 82) | (−48; −40; 21; 74; 80) | (−53; −46; 17; 73; 79) | (−58; −51; 15; 72; 78) | (−63; −55; 13; 77; 80) | |
T Frontal Axis (°) | Male | (−18; −10; 35; 71; 75) | (−20; −12; 35; 73; 77) | (−23; −13; 39; 77; 83) | (−26; −15; 43; 81; 88) | (−27; −15; 48; 85; 95) | (−28; −18; 52; 90; 102) | (−37; −14; 55; 95; 99) |
Female | (−12; −4; 36; 69; 72) | (−16; −8; 36; 72; 76) | (−18; −9; 38; 77; 83) | (−18; −8; 42; 81; 90) | (−21; −10; 46; 85; 95) | (−23; −12; 50; 89; 99) | (−26; −11; 52; 97; 104) | |
Overall P Duration (ms) | Male | (76; 82; 110; 136; 140) | (78; 84; 110; 136; 140) | (78; 84; 112; 138; 144) | (74; 82; 114; 140; 146) | (72; 78; 114; 142; 146) | (68; 74; 114; 146; 150) | (62; 72; 114; 146; 150) |
Female | (74; 80; 106; 134; 138) | (76; 80; 106; 136; 140) | (76; 82; 108; 136; 142) | (76; 80; 110; 138; 144) | (72; 78; 112; 142; 146) | (68; 74; 112; 144; 150) | (68; 72; 112; 144; 148) | |
Overall PR Interval (ms) | Male | (108; 112; 150; 204; 216) | (108; 112; 152; 204; 216) | (106; 114; 152; 208; 220) | (108; 114; 154; 216; 228) | (108; 114; 158; 230; 246) | (108; 114; 164; 246; 268) | (106; 115; 166; 253; 289) |
Female | (102; 106; 144; 194; 206) | (102; 106; 144; 194; 204) | (104; 110; 148; 200; 210) | (104; 110; 150; 208; 218) | (106; 110; 154; 214; 230) | (106; 112; 156; 232; 244) | (106; 108; 160; 241; 251) | |
Overall QRS Duration (ms) | Male | (76; 78; 96; 114; 116) | (76; 78; 94; 114; 116) | (74; 76; 94; 114; 116) | (74; 76; 94; 114; 116) | (74; 76; 94; 114; 116) | (72; 76; 94; 116; 116) | (70; 72; 92; 116; 118) |
Female | (70; 72; 88; 108; 110) | (72; 72; 88; 108; 112) | (72; 74; 90; 110; 112) | (72; 74; 90; 110; 114) | (70; 72; 90; 112; 114) | (70; 72; 88; 112; 116) | (66; 70; 88; 110; 112) | |
QT Interval (ms) | Male | (324; 334; 392; 458; 468) | (328; 336; 396; 460; 472) | (328; 336; 398; 466; 478) | (328; 338; 402; 472; 484) | (326; 336; 404; 474; 486) | (320; 332; 406; 476; 488) | (307; 319; 400; 480; 491) |
Female | (326; 334; 392; 452; 460) | (328; 338; 396; 458; 468) | (332; 340; 402; 466; 474) | (330; 338; 402; 470; 480) | (328; 338; 402; 470; 478) | (320; 332; 400; 470; 480) | (309; 319; 394; 473; 480) | |
QTc Hodges (ms) | Male | (368; 372; 404; 445; 451) | (371; 375; 407; 450; 456) | (374; 378; 411; 454; 461) | (375; 380; 414; 459; 466) | (377; 382; 417; 462; 468) | (378; 383; 421; 465; 470) | (380; 385; 420; 471; 478) |
Female | (379; 383; 414; 452; 458) | (381; 385; 418; 456; 462) | (382; 387; 421; 460; 466) | (383; 388; 423; 464; 470) | (383; 388; 424; 464; 469) | (382; 388; 425; 465; 470) | (381; 385; 423; 465; 470) | |
QTc Bazett (ms) | Male | (363; 369; 411; 457; 463) | (367; 372; 414; 462; 468) | (370; 376; 418; 465; 471) | (373; 379; 421; 468; 474) | (375; 382; 426; 472; 478) | (379; 385; 431; 475; 479) | (375; 386; 434; 479; 484) |
Female | (382; 388; 429; 470; 476) | (385; 391; 432; 473; 478) | (386; 392; 435; 475; 480) | (386; 393; 437; 476; 481) | (389; 395; 439; 478; 481) | (389; 396; 441; 480; 483) | (383; 397; 442; 483; 485) | |
QTc Fridericia (ms) | Male | (367; 371; 404; 443; 449) | (370; 374; 407; 448; 454) | (372; 377; 411; 452; 458) | (374; 378; 414; 456; 461) | (374; 380; 418; 461; 465) | (376; 381; 421; 463; 467) | (377; 380; 420; 471; 473) |
Female | (377; 382; 416; 454; 459) | (379; 384; 419; 458; 463) | (381; 386; 423; 461; 465) | (381; 387; 425; 463; 468) | (380; 386; 426; 464; 467) | (377; 384; 427; 465; 469) | (371; 382; 425; 468; 470) | |
QTc Framingham (ms) | Male | (365; 370; 404; 442; 448) | (368; 373; 407; 447; 453) | (371; 376; 410; 451; 457) | (373; 378; 414; 455; 460) | (375; 380; 417; 460; 464) | (376; 382; 420; 462; 466) | (375; 380; 420; 470; 473) |
Female | (379; 383; 416; 453; 458) | (381; 386; 419; 457; 462) | (382; 387; 423; 460; 464) | (383; 388; 424; 463; 467) | (381; 388; 426; 463; 467) | (380; 386; 426; 465; 468) | (375; 381; 424; 465; 469) |