Key result
Adding body mass index and spatial QRS-T angle to the Sokolow-Lyon product criterion improved the area under the curve for detecting left ventricular hypertrophy from 0.62 to 0.75.
Why the study?
LVH is an important risk factor for adverse cardiovascular outcomes, making the improvement of widely used electrocardiographic LVH criteria desirable.
Does adding body mass index and spatial QRS-T angle to conventional electrocardiographic criteria improve the detection of left ventricular hypertrophy in middle-aged adults?
Cross-Sectional (n=1,091)
No
Does adding body mass index and spatial QRS-T angle to conventional electrocardiographic criteria improve the detection of left ventricular hypertrophy in middle-aged adults?
Absolute Event Rate: 0.75% vs 0.62%
Adding body mass index and spatial QRS-T angle to conventional electrocardiographic criteria improves the diagnostic accuracy for detecting left ventricular hypertrophy.
May aid ECG detection of LVH in middle-aged adults; hypothesis-generating from cross-sectional data, requiring prospective validation.
We investigated improvement of electrocardiographic LVH detection by adding measures of adiposity and/or novel electrocardiographic measures. Left ventricular hypertrophy (LVH) is an important risk factor for adverse cardiovascular outcomes. Improvement of electrocardiographic criteria for LVH is desirable, since electrocardiography is widely used. We included 1091 participants of the Netherlands Epidemiology of Obesity Study (NEO) who underwent cardiac magnetic resonance imaging (MRI). Performance of Sokolow–Lyon and Cornell voltage and product criteria was assessed. Stepwise regression analysis was performed with each conventional electrocardiographic criterion and age, sex, body mass index (BMI), waist circumference, and waist:hip ratio (p-entry < 0.05, p-removal > 0.10). T-wave abnormalities or the spatial QRS-T angle (SA) were added to the improved models. The study population had a mean (SD) age of 56 (6) years, BMI of 26.1 (4.0) kg/m2 and 46% were men. MRI-LVH was present in 10% of participants. The c-statistic for Sokolow–Lyon voltage was 0.58, R2 was 0.02 and sensitivity at 90% specificity was 16%, for Sokolow–Lyon product this was 0.62, 0.02, and 21%, for Cornell voltage 0.65, 0.04, and 28% and for Cornell product 0.67, 0.04, and 25%. Best performing models were obtained by addition of both BMI and SA (Sokolow-Lyon voltage: c-statistic 0.74, R2 0.11, sensitivity of 41% at 90% specificity; Sokolow-Lyon product: 0.75, 0.12, 42%; Cornell voltage: c-statistic 0.70, R2 0.08, sensitivity of 38% at 90% specificity; Cornell product: c-statistic 0.72, R2 0.08, sensitivity of 44% at 90% specificity). Electrocardiographic detection of LVH improved by adding BMI and SA to a model with conventional electrocardiographic criteria. This approach would require little extra effort and application in clinical practice is feasible. However, results should first be replicated in high-risk populations.
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Elffers et al. (2019) conducted a cross-sectional in Left ventricular hypertrophy (n=1,091). Addition of body mass index and spatial QRS-T angle to electrocardiographic criteria vs. Conventional electrocardiographic criteria alone was evaluated on Area under the curve (AUC) for detection of left ventricular hypertrophy (Sokolow-Lyon product model) (95% CI 0.71-0.79). Adding body mass index and spatial QRS-T angle to the Sokolow-Lyon product criterion improved the area under the curve for detecting left ventricular hypertrophy from 0.62 to 0.75.
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