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

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 weig...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037604/
https://www.ncbi.nlm.nih.gov/pubmed/27486142
http://dx.doi.org/10.1136/heartjnl-2015-309201
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author 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
author_facet 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
author_sort Rider, Oliver J
collection PubMed
description 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/m(2)) 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/m(2)). 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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spelling pubmed-50376042016-10-17 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 Heart Special Populations 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/m(2)) 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/m(2)). 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. BMJ Publishing Group 2016-10-01 2016-08-02 /pmc/articles/PMC5037604/ /pubmed/27486142 http://dx.doi.org/10.1136/heartjnl-2015-309201 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Special Populations
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
title Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity
title_full Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity
title_fullStr Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity
title_full_unstemmed Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity
title_short Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity
title_sort improvements in ecg accuracy for diagnosis of left ventricular hypertrophy in obesity
topic Special Populations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037604/
https://www.ncbi.nlm.nih.gov/pubmed/27486142
http://dx.doi.org/10.1136/heartjnl-2015-309201
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