We present a novel methodology that generates a three-dimensional (3D) electrocardiogram (ECG) directly derived from standard two-dimensional (2D) recordings using conventional cardiac electrode configurations. Through spherical-to-Cartesian coordinate transformations, we generate 3D representations that form loops over the standard deflections used in routine medical practice, while geometrically integrating time with voltage within the coordinates themselves. To validate our approach from a clinical perspective, we analyzed datasets focused on acute myocardial ischemia. We evaluated the diagnostic value by comparing 2D and 3D ECG metrics, specifically perimeter and curvature, across different ischemic states. Additionally, we propose a novel mathematical formulation, analogous to curvature, designed to more accurately detect variations in the progression of ischemia. This formulation, referred to as “almost-curvature”, achieves maximum efficiency when integrated with our 3D representation method. Our results highlighted significant geometric differences in the 3D metrics, demonstrating their potential to detect ischemic alterations with greater effectiveness than traditional methods. These findings support the potential of 3D ECG as a transformative tool in cardiac diagnostics and underscore the need for continued research to expand its clinical applicability.

The authors have declared no competing interest.

This study did not receive any funding

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The study used ONLY openly available human data that were originally located at: https://physionet.org, https://physionet.org/content/staffiii/1.0.0/

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