Key result
Adjusting electrocardiographic criteria for left ventricular hypertrophy with visceral fat level significantly improved the area under the curve for detecting LVH compared to BMI adjustment.
Why the study?
Standard ECG criteria for left ventricular hypertrophy offer poor performance, especially among obese patients, prompting investigation into whether adding visceral fat level improves diagnostic accuracy.
Does adjusting standard ECG criteria with visceral fat level improve the diagnostic accuracy of left ventricular hypertrophy compared to unadjusted or BMI-adjusted criteria?
Cross-Sectional (n=1,722)
No
Does adjusting standard ECG criteria with visceral fat level improve the diagnostic accuracy of left ventricular hypertrophy compared to unadjusted or BMI-adjusted criteria?
Adjusting standard ECG criteria for left ventricular hypertrophy with visceral fat level significantly improves diagnostic sensitivity and accuracy compared to unadjusted or BMI-adjusted criteria.
BACKGROUND: Left ventricular hypertrophy (LVH) is a well-known risk factor for cardiovascular events. Even though there are many electrocardiographic (ECG) criteria for LVH, they still provide poor performance, especially among obese patients. The aim of this study was to examine whether adding visceral fat to ECG LVH criteria improves accuracy in the diagnosis. METHODS: One thousand seven hundred twenty two patients were included in the study. All patients underwent a complete physical examination, office blood pressure measurement, analysis of body composition, 12-lead ECG, and M-mode two-dimensional echocardiography. Four standard ECG criteria for LVH were analyzed, including Cornell voltage criteria, Cornell duration criteria, Sokolow-Lyon voltage criteria, and Sokolow-Lyon product criteria. Adjustments of ECG LVH criteria were performed using visceral fat level (VFATL) and BMI. Transthoracic echocardiography was used as a reference method to compare the quality of ECG LVH criteria. RESULTS: Multivariate logistic regression models were created and revealed a significant increase of area under curve (AUC) after VFATL and BMI addition to ECG LVH criteria. Improvement of sensitivity at 90% specificity was observed in all created models. The odds ratio (OR) of the analyzed ECG criteria increased after adding VFATL and BMI to the models. Furthermore, ROC curves analysis exposed better characteristics in detecting LVH of VFATL-adjusted criteria than BMI-adjusted and unadjusted criteria. CONCLUSIONS: Adjusting ECG indexes to BMI or VFATL improves the sensitivity of LVH detection. VFATL-corrected indexes are more sufficiently than BMI-corrected. After advancements in indexes, both lean and morbidly obese individuals outcomes show a greater prevalence of correct LVH diagnosis.
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Salamaga et al. (2021) conducted a cross-sectional in Left ventricular hypertrophy (n=1,722). Visceral fat level (VFATL) correction of ECG criteria vs. BMI correction of ECG criteria was evaluated on Area under the curve (AUC) for detection of LVH using Cornell product (p=0.0015). Adjusting electrocardiographic criteria for left ventricular hypertrophy with visceral fat level significantly improved the area under the curve for detecting LVH compared to BMI adjustment.
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