Researchers at Wake Forest University School of Medicine have developed a new method for assessing biological development in children and adolescents using a standard electrocardiogram (ECG).
The method, known as the Electrocardiographic Sex Index (ESI), is an AI-based score that analyzes ECG data on a continuous scale. The findings were published in the European Heart Journal - Digital Health.
Study Methodology
The study analyzed 61,930 ECGs from children aged 0 to 18 years. The data was sourced from the University of Tennessee Health Science Center's clinical ECG archive.
The ESI model, originally trained on adult data, was applied to these pediatric ECGs without retraining or recalibration. This allowed researchers to observe how ECG features changed relative to adult benchmarks as children aged.
Key Findings
- Early Childhood: ESI values were similar across all children, regardless of biological sex.
- Late Childhood and Adolescence: ESI values began to diverge, reflecting differences associated with normal growth and hormonal changes.
- Racial Trends: The same age-related patterns in ESI values were observed consistently across all racial groups.
- Model Accuracy: The accuracy of the ESI model in predicting biological development improved as children aged, approaching adult-level performance in older adolescents.
Researcher Statements
"ESI offers a continuous measure that may help researchers account for developmental stage when direct puberty or hormone data are not available."
— Tolga Hayit, Ph.D., co-lead author
"ECGs, when coupled with AI approaches, can reveal patterns of maturation and cardiovascular development at scale."
— Ibrahim Karabayir, Ph.D., co-first author
Significance and Next Steps
The authors suggest that ESI may be particularly useful in large studies where Tanner staging (a standard measure of physical development) or hormone data are unavailable.
The study establishes a foundation for future research but does not assess clinical outcomes. The researchers emphasize that further longitudinal studies incorporating Tanner staging, hormone measurements, and clinical outcomes are needed to evaluate the full significance of the ESI method and its potential to inform understanding of cardiovascular risk, treatment response, and long-term health outcomes.