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Evaluation of sensitivity and specificity of ECG left ventricular hypertrophy criteria in obese and hypertensive patients
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
open access
Abstract
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.
Abstract
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.
Keywords
obesity; left ventricular hypertrophy; electrocardiography; hypertension
Title
Evaluation of sensitivity and specificity of ECG left ventricular hypertrophy criteria in obese and hypertensive patients
Journal
Issue
Article type
Original paper
Pages
223-231
Published online
2023-09-11
Page views
607
Article views/downloads
236
DOI
Bibliographic record
Arterial Hypertension 2023;27(4):223-231.
Keywords
obesity
left ventricular hypertrophy
electrocardiography
hypertension
Authors
Szymon Salamaga
Iwona Juszczyk
Franciszek Dydowicz
Mateusz Matyjasek
Agnieszka Turowska
Dawid Lipski
Regina Pawlak-Chomicka
Andrzej Tykarski
Paweł Uruski
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