Sex-Specific Disparities in Diagnostic ECG Interpretation for Myocardial Ischemia
Sex differences in cardiac anatomy and electrophysiology may contribute to disparities in electrocardiographic detection of myocardial ischemia. This brief examines how those differences may affect diagnostic performance, care delays, and healthcare use.
The research question
How might sex-based differences in cardiac anatomy and electrophysiology affect ECG interpretation and the detection of myocardial ischemia?
Methods
This narrative review synthesized evidence on cardiac position, conduction intervals, waveform amplitude, and the diagnostic performance of electrocardiography in women and men. It considered both resting ECG characteristics and the sensitivity of exercise electrocardiograms, then connected those findings with diagnostic timing and healthcare utilization.
Key findingsReviewed findings described lower QRS amplitudes, shorter QRS durations, longer corrected QT intervals, and reduced exercise electrocardiogram sensitivity among women. Together, these patterns may help explain why myocardial ischemia can be missed or identified later in women, potentially contributing to additional testing and greater healthcare utilization.
What the findings could mean
A single approach to ECG interpretation may not perform equally across sexes. Greater attention to sex-related electrophysiologic differences and atypical symptoms could help clinicians recognize when a borderline ECG warrants further evaluation.
What comes next
Future studies should prospectively test sex-specific interpretation thresholds, evaluate their accuracy across diverse patient populations, and compare follow-up strategies for persistent symptoms with borderline findings. Additional imaging pathways should be assessed for clinical benefit, cost, and equity before broad adoption.