Diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy among various body mass index groups compared to diagnosis by cardiac magnetic resonance imaging.

BACKGROUND: Presence of left ventricular hypertrophy (LVH) increases the risk for cardiovascular event. Many electrocardiographic (ECG) criteria can be used to diagnose LVH; however, high body mass index (BMI) may reduce ECG amplitudes.The aim of this study was to investigate the diagnostic performance of ECG criteria for diagnosing LVH among various BMI groups compared to diagnosis by cardiac magnetic resonance (CMR) imaging. METHODS: Patients who were referred for CMR were enrolled. CMR and ECG were performed on the same day. Left ventricular function, volume, and mass were calculated from CMR. Standard ECG criteria were measured, including: Cornell voltage, Cornell product, Romhilt-Estes point score system, Sokolow-Lyon index, and Sokolow-Lyon-Rappaport index. Diagnostic performance of each ECG criterion was calculated and analyzed in the following four BMI groups: underweight (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23-24.9 kg/m2 ), and obese (≥25 kg/m2 ). RESULTS: Of the 1,882 patients that were included, 67 were underweight, 459 were normal weight, 434 were overweight, and 922 were obese. LVH was diagnosed in 34 (50.7%) underweight, 144 (31.4%) normal weight, 100 (23.0%) overweight, and 181 (19.6%) obese patients. Overall specificity of ECG was high (0.89-0.95), and overall sensitivity was low (0.25-0.37). The specificity of each ECG criterion was similar among BMI groups; however, the sensitivity of ECG criteria demonstrated a decreasing trend in the higher BMI groups. CONCLUSION: All ECG criteria demonstrated relatively high specificity and relatively low sensitivity. Although the specificity across groups remained similar, higher BMI was found to be associated with decreased sensitivity.

Accuracy of ECG criteria for the diagnosis of left ventricular hypertrophy: a comparison with magnetic resonance imaging.

BACKGROUND: There are many ECG criteria for the diagnosis of left ventricular hypertrophy (LVH). There are, however limited data on the accuracy of these criteria in comparison with cardiac magnetic resonance (CMR). OBJECTIVE: To determine the accuracy of ECG criteria for the diagnosis of LVH using CMR as the gold standard and to assess gender-specific data. MATERIAL AND METHOD: Patients who were referred for CMR for clinical purposes were studied. ECG and CMR were performed on the same day. Functional CMR protocol was performed for the assessment of cardiac volume, function and mass. CMR variables were indexed by the adjustment of body surface area. The following ECG criteria were used: Romhilt-Estes criteria (score at least 4 or 5 points were used in the present study), Sokolow-Lyon and Sokolow-Lyon-Rappaport, Cornell voltage and Cornell product, and sum of QRS voltage of all 12 leads. CMR of 184 subjects (120females, 64 males) free of cardiovascular disease was used as controls. Patients with left ventricular mass index above 95 percentile of gender specific left ventricular mass in control group were considered LVH. Diagnostic yield of ECG criteria for LVH was calculated for the whole group and each gender RESULTS: There were a total of 1,882 patients, 994 males and 888 females. Average age was 64.6 +/- 11.3 years. LVH was diagnosed by CMR in 23.3% in female and 25.4% in male. ECG criteria for the diagnosis of LVH had a relatively low sensitivity (0.25-0.61), and high specificity (0.75-0.95). Female had a lower sensitivity, higher specificity, higher PPV similar NPV and higher overall accuracy than male. Cornell product, Romhilt-Estes (at least 4 points) and Sokolow-Lyon were the ECG criteria with the best accuracy, sensitivity and specificity, respectively. CONCLUSION: ECG criteria for the diagnosis of LVH had a relatively low sensitivity, and high specificity. The accuracy was in the range of 0.71-0.80. Cornell product had the highest accuracy.