Electrocardiograms (ECGs) are one of the most widely used tools in diagnosing heart conditions, but their accuracy can be affected by natural variations in individual heart anatomy. Traditional ECG interpretation often assumes a standard heart position, ignoring differences caused by body mass index (BMI), sex, and hypertension. These anatomical variations can significantly alter the electrical signals captured by ECGs, leading to potential misdiagnoses. In particular, the horizontal orientation of the heart in individuals with higher BMI or high blood pressure causes corresponding shifts in ECG readings. The challenge lies in distinguishing normal anatomical differences from early signs of disease. Now, a new study has revealed how the physical orientation of the heart inside the chest dramatically influences the electrical signals captured in an ECG, paving the way for more personalized and accurate heart diagnostics.

The study was conducted by scientists at King's College London (London, UK) and involved over 39,000 participants from the UK Biobank, making it one of the largest population-based studies of its kind. The team combined 3D heart imaging with ECG data to create simplified, personalized digital twins of each participant’s heart. These models enabled the researchers to investigate how the heart's anatomical axis aligns with the electrical axis. Digital twins are proving to be a transformative tool in cardiovascular research, offering the ability to simulate and study the heart’s structure and function with remarkable precision. The study proposed new, standardized definitions for anatomical and electrical axes based on their alignment in 3D space. It also demonstrated how large-scale biomedical resources like the UK Biobank support detailed analysis of anatomical and electrophysiological variability, laying the groundwork for patient-centric disease characterization.

The model revealed clear patterns that varied by sex and health status. Men generally had more horizontally oriented hearts than women, and this anatomical difference was reflected in their ECG readings. The study also identified and quantified this variability across the population, emphasizing the importance of recognizing individual anatomical differences to better detect early signs of conditions such as hypertension, conduction abnormalities, and early heart muscle changes. These findings, published in Nature Communications, point to a future where ECGs are interpreted based on personalized anatomical data, reducing diagnostic errors and supporting more targeted clinical interventions. Researchers plan to continue refining the use of digital twins to identify new parameters for early detection of cardiovascular conditions and ultimately propose more accurate, anatomy-based diagnostic methods.

"The ability to build personalized models (i.e. digital twins) of the cardiovascular system is an exciting research area, where we hope to find new parameters that can better inform about prevention, diagnosis and risks of cardiovascular diseases. In this work, we start to explore these uncharted waters, and we hope we will soon propose new ways to early detect conditions such as electrical conduction disorders," said KCL Professor Pablo Lamata, senior author of the study.

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