Classification Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Normal Weight and Overweight Older Adults

Background: We evaluated classification accuracy of ECG criteria at varying levels of left ventricular hypertrophy (LVH) severity according to echocardiographically measured left ventricular mass (LVM) adjusted to body size. Methods: The test population was derived from the Cardiovascular Health Study (CHS), a population‐based sample of 5201 men and women aged 65 and older, and consisted of 1844 women and 1119 men with adequate quality ECGs and echocardiograms for LVM determination. The criteria evaluated were Sokolow‐Lyon, Cornell voltage, Cornell product, Framingham modification of the Cornell voltage, and the left ventricular mass index (LVMI) of the Novacode ECG program. Results: With LVH thresholds at upper 95% normal limit for weight adjusted LVM for the CHS population and ECG thresholds adjusted for 95% specificity in normal weight and overweight subgroups, the sensitivity of ECG criteria for LVH was relatively low. It was highest (40.8%) for the Novacode LVMI in normal weight men and for the Framingham criteria (30.9%) in normal weight women, but it deteriorated for both of these criteria in the presence of obesity. The overall performance of the Cornell product and Cornell voltage criteria was least influenced by obesity. The Framingham adjustment for the Cornell voltage criteria for obesity substantially reduced their sensitivity. Conclusion: The choice of echocardiographic standard, LVH severity level and overweight in the test groups have a strong influence on ECG evaluation results.