H. Jeff Smith

Lei Li, Hannah Smith, Yilin Lyu et al.

Cardiac digital twins (CDTs) offer personalized in-silico cardiac representations for the inference of multi-scale properties tied to cardiac mechanisms. The creation of CDTs requires precise information about the electrode position on the torso, especially for the personalized electrocardiogram (ECG) calibration. However, current studies commonly rely on additional acquisition of torso imaging and manual/semi-automatic methods for ECG electrode localization. In this study, we propose a novel and efficient topology-informed model to fully automatically extract personalized ECG standard electrode locations from 2D clinically standard cardiac MRIs. Specifically, we obtain the sparse torso contours from the cardiac MRIs and then localize the standard electrodes of 12-lead ECG from the contours. Cardiac MRIs aim at imaging of the heart instead of the torso, leading to incomplete torso geometry within the imaging. To tackle the missing topology, we incorporate the electrodes as a subset of the keypoints, which can be explicitly aligned with the 3D torso topology. The experimental results demonstrate that the proposed model outperforms the time-consuming conventional model projection-based method in terms of accuracy (Euclidean distance: $1.24 \pm 0.293$ cm vs. $1.48 \pm 0.362$ cm) and efficiency ($2$~s vs. $30$-$35$~min). We further demonstrate the effectiveness of using the detected electrodes for in-silico ECG simulation, highlighting their potential for creating accurate and efficient CDT models. The code is available at https://github.com/lileitech/12lead_ECG_electrode_localizer.

Hannah J. Smith, Blanca Rodriguez, Yuling Sang et al. · oxford

The electrocardiogram (ECG) is used for diagnosis and risk stratification following 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 anatomy features. 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. For post-MI women, the heart is positioned more posteriorly and vertically, than in men (with healthy women yet more vertical). Post-MI women exhibit less QRS prolongation, requiring 27% more prolongation than men to exceed 120ms. Only half of the sex difference in QRS is associated with smaller female cavities. Lower STj amplitude in women is striking, associated with smaller ventricles, but also more superior and posterior cardiac position. Post-MI, T wave amplitude and R axis deviations are strongly associated with a more posterior and horizontal cardiac position in women (but not 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.