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Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: The electrocardiogram (ECG) is the most commonly used tool to screen for left ventricular hypertrophy (LVH), and yet current diagnostic criteria are insensitive in modern increasingly overweight society. We propose a simple adjustment to improve diagnostic accuracy in different body weights and improve the sensitivity of this universally available technique.

Methods: Overall, 1295 participants were included—821 with a wide range of body mass index (BMI 17.1–53.3 kg/m2) initially underwent cardiac magnetic resonance evaluation of anatomical left ventricular (LV) axis, LV mass and 12-lead surface ECG in order to generate an adjustment factor applied to the Sokolow–Lyon criteria. This factor was then validated in a second cohort (n=520, BMI 15.9–63.2 kg/m2).

Results: When matched for LV mass, the combination of leftward anatomical axis deviation and increased BMI resulted in a reduction of the Sokolow–Lyon index, by 4 mm in overweight and 8 mm in obesity. After adjusting for this in the initial cohort, the sensitivity of the Sokolow–Lyon index increased (overweight: 12.8% to 30.8%, obese: 3.1% to 27.2%) approaching that seen in normal weight (37.8%). Similar results were achieved in the validation cohort (specificity increased in overweight: 8.3% to 39.1%, obese: 9.4% to 25.0%) again approaching normal weight (39.0%). Importantly, specificity remained excellent (>93.1%).

Conclusions: Adjusting the Sokolow–Lyon index for BMI (overweight +4 mm, obesity +8 mm) improves the diagnostic accuracy for detecting LVH. As the ECG, worldwide, remains the most widely used screening tool for LVH, implementing these findings should translate into significant clinical benefit.

No MeSH data available.


Related in: MedlinePlus

Defining the coronal anatomical left ventricular axis using multiplanar reconstruction. Images show the coronal axis in the (A) short axis, (B) vertical long axis and (C) horizontal axis views.
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HEARTJNL2015309201F2: Defining the coronal anatomical left ventricular axis using multiplanar reconstruction. Images show the coronal axis in the (A) short axis, (B) vertical long axis and (C) horizontal axis views.

Mentions: The anatomical axis of the LV was determined in the coronal and sagittal planes using multiplanar reconstruction of transverse thoracic HASTE images within cmr42 (Circle Cardiovascular Imaging, Calgary, Canada). The anatomical LV axis was defined as the plane between the centre of the mitral valve and the LV apex determined on both the horizontal and vertical long axis views. The LV axis in both planes (degrees 0° horizontal) was determined using a commercially available screen protractor (Screen Protractor 4.0, Iconico, New York, USA). Representative images of this process are shown in figure 2.


Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity
Defining the coronal anatomical left ventricular axis using multiplanar reconstruction. Images show the coronal axis in the (A) short axis, (B) vertical long axis and (C) horizontal axis views.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037604&req=5

HEARTJNL2015309201F2: Defining the coronal anatomical left ventricular axis using multiplanar reconstruction. Images show the coronal axis in the (A) short axis, (B) vertical long axis and (C) horizontal axis views.
Mentions: The anatomical axis of the LV was determined in the coronal and sagittal planes using multiplanar reconstruction of transverse thoracic HASTE images within cmr42 (Circle Cardiovascular Imaging, Calgary, Canada). The anatomical LV axis was defined as the plane between the centre of the mitral valve and the LV apex determined on both the horizontal and vertical long axis views. The LV axis in both planes (degrees 0° horizontal) was determined using a commercially available screen protractor (Screen Protractor 4.0, Iconico, New York, USA). Representative images of this process are shown in figure 2.

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: The electrocardiogram (ECG) is the most commonly used tool to screen for left ventricular hypertrophy (LVH), and yet current diagnostic criteria are insensitive in modern increasingly overweight society. We propose a simple adjustment to improve diagnostic accuracy in different body weights and improve the sensitivity of this universally available technique.

Methods: Overall, 1295 participants were included—821 with a wide range of body mass index (BMI 17.1–53.3 kg/m2) initially underwent cardiac magnetic resonance evaluation of anatomical left ventricular (LV) axis, LV mass and 12-lead surface ECG in order to generate an adjustment factor applied to the Sokolow–Lyon criteria. This factor was then validated in a second cohort (n=520, BMI 15.9–63.2 kg/m2).

Results: When matched for LV mass, the combination of leftward anatomical axis deviation and increased BMI resulted in a reduction of the Sokolow–Lyon index, by 4 mm in overweight and 8 mm in obesity. After adjusting for this in the initial cohort, the sensitivity of the Sokolow–Lyon index increased (overweight: 12.8% to 30.8%, obese: 3.1% to 27.2%) approaching that seen in normal weight (37.8%). Similar results were achieved in the validation cohort (specificity increased in overweight: 8.3% to 39.1%, obese: 9.4% to 25.0%) again approaching normal weight (39.0%). Importantly, specificity remained excellent (>93.1%).

Conclusions: Adjusting the Sokolow–Lyon index for BMI (overweight +4 mm, obesity +8 mm) improves the diagnostic accuracy for detecting LVH. As the ECG, worldwide, remains the most widely used screening tool for LVH, implementing these findings should translate into significant clinical benefit.

No MeSH data available.


Related in: MedlinePlus