How can computerized interpretation algorithms adapt to gender/age differences in ECG measurements?

It is well known that there are gender differences in 12 lead ECG measurements, some of which can be statistically significant. It is also an accepted practice that we should consider those differences when we interpret ECGs, by either a human overreader or a computerized algorithm. There are some major gender differences in 12 lead ECG measurements based on automatic algorithms, including global measurements such as heart rate, QRS duration, QT interval, and lead-by-lead measurements like QRS amplitude, ST level, etc. The interpretation criteria used in the automatic algorithms can be adapted to the gender differences in the measurements. The analysis of a group of 1339 patients with acute inferior MI showed that for patients under age 60, women had lower ST elevations at the J point in lead II than men (57±91μV vs. 86±117μV, p<0.02). This trend was reversed for patients over age 60 (lead aVF: 102±126μV vs. 84±117μV, p<0.04; lead III: 130±146μV vs. 103±131μV, p<0.007). Therefore, the ST elevation thresholds were set based on available gender and age information, which resulted in 25% relative sensitivity improvement for women under age 60, while maintaining a high specificity of 98%. Similar analyses were done for prolonged QT interval and LVH cases. The paper uses several design examples to demonstrate (1) how to design a gender-specific algorithm, and (2) how to design a robust ECG interpretation algorithm which relies less on absolute threshold-based criteria and is instead more reliant on overall morphology features, which are especially important when gender information is unavailable for automatic analysis.