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

Oliver J. Rider, Ntobeko Ntusi, Sacha C. Bull, Richard Nethononda, Vanessa Ferreira, Cameron J. Holloway, David Holdsworth, Masliza Mahmod, Jennifer J. Rayner, Rajarshi Banerjee, Saul Myerson, Hugh Watkins, Stefan Neubauer

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1566-1572
Number of pages7
JournalHeart
Volume102
Issue number19
DOIs
Publication statusPublished - 1 Oct 2016
Externally publishedYes

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Left Ventricular Hypertrophy
Electrocardiography
Obesity
Weights and Measures
Body Mass Index
Magnetic Resonance Spectroscopy
Body Weight

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rider, O. J., Ntusi, N., Bull, S. C., Nethononda, R., Ferreira, V., Holloway, C. J., ... Neubauer, S. (2016). Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity. Heart, 102(19), 1566-1572. https://doi.org/10.1136/heartjnl-2015-309201

Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity. / Rider, Oliver J.; Ntusi, Ntobeko; Bull, Sacha C.; Nethononda, Richard; Ferreira, Vanessa; Holloway, Cameron J.; Holdsworth, David; Mahmod, Masliza; Rayner, Jennifer J.; Banerjee, Rajarshi; Myerson, Saul; Watkins, Hugh; Neubauer, Stefan.

In: Heart, Vol. 102, No. 19, 01.10.2016, p. 1566-1572.

Research output: Contribution to journalArticle

Rider, OJ, Ntusi, N, Bull, SC, Nethononda, R, Ferreira, V, Holloway, CJ, Holdsworth, D, Mahmod, M, Rayner, JJ, Banerjee, R, Myerson, S, Watkins, H & Neubauer, S 2016, 'Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity', Heart, vol. 102, no. 19, pp. 1566-1572. https://doi.org/10.1136/heartjnl-2015-309201
Rider OJ, Ntusi N, Bull SC, Nethononda R, Ferreira V, Holloway CJ et al. Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity. Heart. 2016 Oct 1;102(19):1566-1572. https://doi.org/10.1136/heartjnl-2015-309201
Rider, Oliver J. ; Ntusi, Ntobeko ; Bull, Sacha C. ; Nethononda, Richard ; Ferreira, Vanessa ; Holloway, Cameron J. ; Holdsworth, David ; Mahmod, Masliza ; Rayner, Jennifer J. ; Banerjee, Rajarshi ; Myerson, Saul ; Watkins, Hugh ; Neubauer, Stefan. / Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity. In: Heart. 2016 ; Vol. 102, No. 19. pp. 1566-1572.
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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.",
author = "Rider, {Oliver J.} and Ntobeko Ntusi and Bull, {Sacha C.} and Richard Nethononda and Vanessa Ferreira and Holloway, {Cameron J.} and David Holdsworth and Masliza Mahmod and Rayner, {Jennifer J.} and Rajarshi Banerjee and Saul Myerson and Hugh Watkins and Stefan Neubauer",
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AU - Ntusi, Ntobeko

AU - Bull, Sacha C.

AU - Nethononda, Richard

AU - Ferreira, Vanessa

AU - Holloway, Cameron J.

AU - Holdsworth, David

AU - Mahmod, Masliza

AU - Rayner, Jennifer J.

AU - Banerjee, Rajarshi

AU - Myerson, Saul

AU - Watkins, Hugh

AU - Neubauer, Stefan

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N2 - 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.

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