Standard ECG criteria for left ventricular hypertrophy showed decreased sensitivity and specificity in obese patients, with Cornell duration criteria demonstrating the best performance.
Cross-Sectional (n=1,722)
Does obesity affect the sensitivity and specificity of standard ECG criteria for detecting left ventricular hypertrophy compared to echocardiography?
Obesity significantly reduces the diagnostic accuracy of standard ECG criteria for left ventricular hypertrophy, making Cornell duration the preferred ECG criterion in this population and highlighting the need to assess visceral fat.
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 the sensitivity and specificity in obese and nonobese patients, with obesity defined using body mass index (BMI), visceral fat level (VFATL) and waist hip ratio (WHR). Material and methods: Overall, 1722 patients were included in the study. All patients underwent complete physical examination, office blood pressure measurement, analysis of body composition, 12-lead ECG, M-mode two-dimensional echocardiography. Six standard ECG criteria for LVH were analyzed, including: Cornell voltage criteria, Cornell duration criteria, Sokolow- Lyon voltage criteria, Sokolow-Lyon product criteria, R I + S III and R wave of aVL. Sensitivity and specificity of those criteria was evaluated for patients with and without obesity. Transthoracic echocardiography was used as a reference method to detect LVH. Results: In obese patients, Cornell duration criteria showed the best performance and should be used in detecting LVH. Increased amount of adipose tissue and presence of obesity, defined by different indicators, decreased sensitivity and specificity values of ECG criteria; however, only several criteria showed statistical significance. Sokolov-Lyon voltage and Cornel voltage were evaluated to have good sensitivity in nonobese women patients, but their performance was insufficient in obese women. Conclusion: LVH should not be diagnosed using ECG criteria without assessment of patients obesity. Preferred parameter, from discussed in this study, to assess patients obesity is VFATL.
Salamaga et al. (Tue,) conducted a cross-sectional in Left ventricular hypertrophy (n=1,722). Standard ECG criteria for LVH vs. Transthoracic echocardiography (reference) was evaluated on Sensitivity and specificity of ECG criteria for detecting LVH. Standard ECG criteria for left ventricular hypertrophy showed decreased sensitivity and specificity in obese patients, with Cornell duration criteria demonstrating the best performance.