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Prognostic significance of body mass index-adjusted criteria for left ventricular hypertrophy

Hesham Afify1, Ho Lim Lee2, Elsayed Z Soliman3,4

  • 1Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA.

Journal of Clinical Hypertension (Greenwich, Conn.)
|August 8, 2020
PubMed

Insights

Body mass index (BMI) adjusted electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria may identify more cases but can reduce prognostic accuracy for cardiovascular and all-cause mortality.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Public Health

Background:

  • Electrocardiographic left ventricular hypertrophy (ECG-LVH) is a known predictor of cardiovascular and all-cause mortality.
  • Obesity can decrease the sensitivity of standard ECG-LVH criteria, leading to the development of BMI-adjusted criteria.
  • The prognostic value of these BMI-adjusted ECG-LVH criteria remains unclear.

Purpose of the Study:

  • To evaluate the prognostic significance of BMI-adjusted ECG-LVH criteria for all-cause and cardiovascular mortality.
  • To compare the performance of BMI-adjusted Cornell and Sokolow-Lyon criteria against their traditional counterparts.

Main Methods:

  • Analysis of 7812 participants from the Third National Health and Nutrition Examination Survey.
  • Assessment of traditional Cornell and Sokolow-Lyon ECG-LVH criteria.
  • Evaluation of BMI-adjusted Cornell (product of voltage and BMI) and Sokolow-Lyon (voltage adjusted for BMI categories) criteria.
  • Multivariable-adjusted Cox proportional hazards models were used to assess mortality risk.

Main Results:

  • BMI-adjusted criteria identified a higher prevalence of ECG-LVH compared to traditional criteria (Cornell: 9.9% vs 2.9%; Sokolow-Lyon: 13.1% vs 6.4%).
  • BMI-adjusted Sokolow-Lyon criteria showed no improved prognostic performance over traditional criteria for all-cause and cardiovascular mortality.
  • BMI-adjusted Cornell voltage criteria attenuated the association with both all-cause and cardiovascular mortality.

Conclusions:

  • While BMI-adjusted ECG-LVH criteria may increase LVH detection rates, they may also diminish the criteria's ability to predict mortality.
  • Adjusting ECG-LVH criteria for BMI might lead to a loss of valuable prognostic information.
  • Further research is needed to refine ECG-LVH criteria for diverse populations, considering obesity.

Keywords:
BMI-adjusted criteriaelectrocardiographyleft ventricular hypertrophyobesity

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