TY  -  JOUR
AU  -  Carbone, Vincenzo
AU  -  Guarnaccia, Franco
AU  -  Carbone, Giovanni
AU  -  Zito, Giovanni Battista
AU  -  Oliviero, Ugo
AU  -  Soreca, Silvia
AU  -  Carbone, Francesca
T1  -  Gender differences in the 12-lead electrocardiogram: 
clinical implications and prospects
PY  -  2020
Y1  -  2020-09-01
DO  -  10.1723/3432.34217
JO  -  The Italian Journal of Gender-Specific Medicine
JA  -  Ital J Gender-Specific Med
VL  -  6
IS  -  3
SP  -  126
EP  -  141
PB  -  Il Pensiero Scientifico Editore
SN  -  2612-3487
Y2  -  2026/05/28
UR  -  http://dx.doi.org/10.1723/3432.34217
N2  -  Summary. Many sex differences exist in cardiac electrophysiology which are reflected on surface ECG. All gender-related differences in the repolarization features, including QT duration, J-ST voltages and T-wave morphology, become apparent at puberty, increase quickly and then progressively subside with advancing age. This suggests a strong role of the sex hormones, particularly testosterone, in modulating the ventricular recovery properties. Besides having a longer QT interval at baseline, women experience a greater increase in QT duration after exposure to QT-prolonging drugs, and consequently are more prone than men to develop torsade de pointes in both congenital and acquired long QT syndromes. On the other hand, the J-point elevation occurring in pubescent men – but not in women – may be the basis for male predominance in the Brugada and early repolarization syndromes, such as the higher event rate and worse prognosis reported in affected men. In postmenopausal women, several ECG variables proved to be strong predictors of morbidity and mortality from coronary heart disease, congestive heart failure and all-cause death. In women the ECG changes occurring during exercise test are less accurate than in men in detecting a coronary artery disease, but this difference can be mitigated by choosing wisely the diagnostic test and using other stress data beyond the ST-depression alone. The ECG is a valuable diagnostic and prognostic tool, whose clinical yield can be further enhanced if sex differences are properly taken into account.
ER  -