Open AccessA Population‐wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males—results from the Singapore Armed Forces ECG (SAFE) study
Author(s) -
Sia ChingHui,
Dalakoti Mayank,
Tan Benjamin Y. Q.,
Lee Edward C. Y.,
Shen Xiayan,
Wang Kangjie,
Lee Joshua S.,
Arulanandam Shalini,
Chow Weien,
Yeo Tee Joo,
Yeo Khung Keong,
Chua Terrance S. J.,
Tan Ru San,
Lam Carolyn S. P.,
Chong Daniel T. T.
Publication year - 2019
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12634
Subject(s) - medicine , qrs complex , anthropometry , blood pressure , body mass index , cardiology , population , diastole , electrocardiography , qt interval , pr interval , demography , heart rate , environmental health , sociology
Background Routine use of pre‐participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. Methods and results Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre‐participation screening that included a 12‐lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m 2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG. Conclusions Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.