DoesQRSVoltage Correction by Body Mass Index Improve the Accuracy of Electrocardiography in Detecting Left Ventricular Hypertrophy and Predicting Cardiovascular Events in a General Population?

Abstract

The authors assessed the value of body mass index (BMI) correction of two electrocardiographic criteria in improving detection of left ventricular hypertrophy (LVH) and prediction of cardiovascular and all-cause mortality in the Italian study Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population. At entry, 1549 patients underwent diagnostic tests, 24-hour ambulatory blood pressure (BP) monitoring, standard electrocardiography, and echocardiography. The BMI-corrected Cornell voltage and Sokolow-Lyon voltage criteria provided better results for detection of echocardiographic LVH as compared with unadjusted electrocardiographic parameters. Cornell voltage index, but not Sokolow-Lyon index, was associated with an increased risk of cardiovascular events (and allcause mortality). The adjusted risk of cardiovascular events related to one-standard deviation increment of BMI-corrected Cornell voltage was similar to that conferred by the uncorrected criterion in the total population, but outperformed in obese participants. These findings show that correction for BMI may improve the diagnostic accuracy of Cornell voltage index in detecting LVH and prediction of cardiovascular mortality in obese individuals.

Novel Approach to the Detection of Left Ventricular Hypertrophy Using Body Mass Index–Corrected Electrocardiographic Voltage Criteria in a Group of African Ancestry

“…Moreover, whether this approach is appropriate in subjects of African ancestry, where the dampening effects of obesity on QRS voltages are particularly striking, 20 is unknown. In keeping with that noted in European populations, we show an improved performance (AUC for ROC) for LVH detection 21,22 using the QRS voltage-BMI product. We nevertheless demonstrate that the best overall performance for LVH detection is by modifying the QRS voltages for R aVL and Lewis criteria in those with BMI ≥29 kg/m 2 by the aforementioned mathematical formula.…”

“…21,22 In the present study, BMI showed no relations with Sokolow-Lyon voltages in those with BMI <29 kg/m 2 and inverse relations with Sokolow-Lyon voltages in those with BMI ≥29 kg/m 2 . Moreover, BMI showed weak relations with Cornell voltages, with no differences in the strength (r value) or slopes (β-coefficients) of these relations in those with BMI <29 kg/m 2 as compared with those with BMI ≥29 kg/m 2 .…”

“…9 -15 This has recently been demonstrated to be in part amended by use of a product of QRS voltage amplitudes and BMI in European populations. 21,22 However, this approach does not correct for the attenuating effect of obesity on QRS voltages, but rather employs BMI together with ECG voltages as a determinant of LVMI. Moreover, whether this approach is appropriate in subjects of African ancestry, where the dampening effects of obesity on QRS voltages are particularly striking, 20 is unknown.…”

“…21,22 This approach improves the overall performance for LVH detection 21,22 and increases the ability of ECG criteria to predict cardiovascular outcomes 22 in groups of European ancestry. However, the BMI-QRS voltage product does not necessarily correct for the attenuating effect of obesity on QRS voltages, but rather employs BMI together with ECG voltages as a determinant of left ventricular mass (LVM).…”

Comparison of the Performance of Three Commonly Used Electrocardiographic Indexes for the Diagnosis of Left Ventricular Hypertrophy in Black Hypertensive Patients with Reduced Kidney Function Managed at a Tertiary Healthcare Hospital: A Post-Hoc Analysis

“…In contrast to the above finding, Cornell voltage in middle-aged subjects was the only ECG index that was associated with LVH detection irrespective of indexation [46]. Another plausible explanation could be the fact that the evidence indicates that the sensitivity of several ECG criteria decreases from normal-weight to overweight and obesity [47]. In this regard, a recent study from Italy found that BMI-corrected Sokolow-Lyon voltage and Cornell voltage criteria provided better results for detection of echocardiographic LVH compared with unadjusted parameters [47].…”