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Visceral fat level correction of the left ventricular hypertrophy electrocardiographic criteria
Szymon Salamaga1, Franciszek Dydowicz1, Agnieszka Turowska1
1Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
Insights
Adding visceral fat (VFATL) to electrocardiogram (ECG) criteria significantly improves the diagnosis of left ventricular hypertrophy (LVH), especially in obese patients. VFATL-adjusted ECGs offer superior accuracy compared to BMI-adjusted or unadjusted criteria for detecting LVH.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular events.
- Existing electrocardiogram (ECG) criteria for LVH diagnosis have limited accuracy, particularly in obese individuals.
- Obesity complicates LVH assessment due to altered body composition and potential confounding factors.
Purpose of the Study:
- To evaluate the efficacy of incorporating visceral fat level (VFATL) into standard ECG criteria for enhancing LVH diagnostic accuracy.
- To compare the diagnostic performance of VFATL-adjusted ECG criteria against body mass index (BMI)-adjusted and unadjusted criteria.
- To determine if VFATL adjustment improves LVH detection across diverse body compositions, including lean and obese patients.
Main Methods:
- A cohort of 1722 patients underwent comprehensive assessments including physical examination, blood pressure measurement, body composition analysis, 12-lead ECG, and echocardiography.
- Four established ECG criteria for LVH (Cornell voltage, Cornell duration, Sokolow-Lyon voltage, Sokolow-Lyon product) were analyzed.
- ECG criteria were adjusted using visceral fat level (VFATL) and BMI, with echocardiography serving as the reference standard.
Main Results:
- Multivariate logistic regression models demonstrated a significant increase in the area under the curve (AUC) when VFATL and BMI were added to ECG LVH criteria.
- Adjusting ECG criteria with VFATL and BMI improved sensitivity at 90% specificity across all models.
- VFATL-adjusted criteria showed superior diagnostic characteristics for LVH detection compared to BMI-adjusted and unadjusted criteria, with increased odds ratios.
Conclusions:
- Adjusting ECG criteria with either BMI or VFATL enhances the sensitivity for detecting LVH.
- VFATL-corrected ECG indexes provide more accurate LVH detection than BMI-corrected indexes.
- These advancements in ECG criteria facilitate more accurate LVH diagnosis in both lean and morbidly obese individuals.
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 whether adding visceral fat to ECG LVH criteria improves accuracy in the diagnosis.
Methods:
One thousand seven hundred twenty two patients were included in the study. All patients underwent a complete physical examination, office blood pressure measurement, analysis of body composition, 12-lead ECG, and M-mode two-dimensional echocardiography. Four standard ECG criteria for LVH were analyzed, including Cornell voltage criteria, Cornell duration criteria, Sokolow-Lyon voltage criteria, and Sokolow-Lyon product criteria. Adjustments of ECG LVH criteria were performed using visceral fat level (VFATL) and BMI. Transthoracic echocardiography was used as a reference method to compare the quality of ECG LVH criteria.
Results:
Multivariate logistic regression models were created and revealed a significant increase of area under curve (AUC) after VFATL and BMI addition to ECG LVH criteria. Improvement of sensitivity at 90% specificity was observed in all created models. The odds ratio (OR) of the analyzed ECG criteria increased after adding VFATL and BMI to the models. Furthermore, ROC curves analysis exposed better characteristics in detecting LVH of VFATL-adjusted criteria than BMI-adjusted and unadjusted criteria.
Conclusions:
Adjusting ECG indexes to BMI or VFATL improves the sensitivity of LVH detection. VFATL-corrected indexes are more sufficiently than BMI-corrected. After advancements in indexes, both lean and morbidly obese individuals outcomes show a greater prevalence of correct LVH diagnosis.
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