The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance
Electrocardiograph (ECG) criteria for left ventricular hypertrophy (LVH) are a widely used clinical tool. We recalibrated six ECG criteria for LVH against gold-standard cardiac magnetic resonance (CMR) and assessed the impact of obesity. One hundred and fifty consecutive tertiary hypertension clinic...
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| Veröffentlicht in: | Journal of human hypertension 2016-03, Vol.30 (3), p.197-203 |
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| creator | Rodrigues, J C L McIntyre, B Dastidar, A G Lyen, S M Ratcliffe, L E Burchell, A E Hart, E C Bucciarelli-Ducci, C Hamilton, M C K Paton, J F R Nightingale, A K Manghat, N E |
| description | Electrocardiograph (ECG) criteria for left ventricular hypertrophy (LVH) are a widely used clinical tool. We recalibrated six ECG criteria for LVH against gold-standard cardiac magnetic resonance (CMR) and assessed the impact of obesity. One hundred and fifty consecutive tertiary hypertension clinic referrals for CMR (1.5 T) were reviewed. Patients with cardiac pathology potentially confounding hypertensive LVH were excluded (
n
=22). The final sample size was 128 (age: 51.0±15.2 years, 48% male). LVH was defined by CMR. From a 12-lead ECG, Sokolow–Lyon voltage and product, Cornell voltage and product, Gubner–Ungerleidger voltage and Romhilt–Estes score were evaluated, blinded to the CMR. ECG diagnostic performance was calculated. LVH by CMR was present in 37% and obesity in 51%. Obesity significantly reduced ECG sensitivity, because of significant attenuation in mean ECG values for Cornell voltage (22.2±5.7 vs 26.4±9.4 mm,
P |
| doi_str_mv | 10.1038/jhh.2015.58 |
| format | Article |
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n
=22). The final sample size was 128 (age: 51.0±15.2 years, 48% male). LVH was defined by CMR. From a 12-lead ECG, Sokolow–Lyon voltage and product, Cornell voltage and product, Gubner–Ungerleidger voltage and Romhilt–Estes score were evaluated, blinded to the CMR. ECG diagnostic performance was calculated. LVH by CMR was present in 37% and obesity in 51%. Obesity significantly reduced ECG sensitivity, because of significant attenuation in mean ECG values for Cornell voltage (22.2±5.7 vs 26.4±9.4 mm,
P
<0.05), Cornell product (2540±942 vs 3023±1185 mm • ms,
P
<0.05) and for Gubner–Ungerleider voltage (18.2±7.1 vs 23.3±1.2 mm,
P
<0.05). Obesity also significantly reduced ECG specificity, because of significantly higher prevalence of LV remodeling (no LVH but increased mass-to-volume ratio) in obese subjects without LVH (36% vs 16%,
P
<0.05), which correlated with higher mean ECG LVH criteria values. Obesity-specific partition values were generated at fixed 95% specificity; Cornell voltage had highest sensitivity in non-obese (56%) and Sokolow–Lyon product in obese patients (24%). Obesity significantly lowers ECG sensitivity at detecting LVH, by attenuating ECG LVH values, and lowers ECG specificity through changes associated with LV remodeling. Our obesity-specific ECG partition values could improve the diagnostic performance in obese patients with hypertension.</description><identifier>ISSN: 0950-9240</identifier><identifier>EISSN: 1476-5527</identifier><identifier>DOI: 10.1038/jhh.2015.58</identifier><identifier>PMID: 26040440</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>59/57 ; 631/443/592/1540 ; 692/499 ; 692/699/75/243 ; Adult ; Aged ; Care and treatment ; Diagnosis ; Electrocardiography - standards ; Epidemiology ; Female ; Health Administration ; Heart enlargement ; Humans ; Hypertension - complications ; Hypertrophy, Left Ventricular - diagnostic imaging ; Hypertrophy, Left Ventricular - etiology ; Magnetic Resonance Imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Obesity ; Obesity - complications ; Original ; original-article ; Practice guidelines (Medicine) ; Prospective Studies ; Public Health ; Risk factors ; Two-dimensional echocardiography</subject><ispartof>Journal of human hypertension, 2016-03, Vol.30 (3), p.197-203</ispartof><rights>The Author(s) 2016</rights><rights>COPYRIGHT 2016 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Mar 2016</rights><rights>Copyright © 2016 Macmillan Publishers Limited 2016 Macmillan Publishers Limited</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c647t-af5963d0142fa6859e47c57dbc6e1c67f387c7debeb203d6c595eeaac5469f03</citedby><cites>FETCH-LOGICAL-c647t-af5963d0142fa6859e47c57dbc6e1c67f387c7debeb203d6c595eeaac5469f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/jhh.2015.58$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/jhh.2015.58$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26040440$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rodrigues, J C L</creatorcontrib><creatorcontrib>McIntyre, B</creatorcontrib><creatorcontrib>Dastidar, A G</creatorcontrib><creatorcontrib>Lyen, S M</creatorcontrib><creatorcontrib>Ratcliffe, L E</creatorcontrib><creatorcontrib>Burchell, A E</creatorcontrib><creatorcontrib>Hart, E C</creatorcontrib><creatorcontrib>Bucciarelli-Ducci, C</creatorcontrib><creatorcontrib>Hamilton, M C K</creatorcontrib><creatorcontrib>Paton, J F R</creatorcontrib><creatorcontrib>Nightingale, A K</creatorcontrib><creatorcontrib>Manghat, N E</creatorcontrib><title>The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance</title><title>Journal of human hypertension</title><addtitle>J Hum Hypertens</addtitle><addtitle>J Hum Hypertens</addtitle><description>Electrocardiograph (ECG) criteria for left ventricular hypertrophy (LVH) are a widely used clinical tool. We recalibrated six ECG criteria for LVH against gold-standard cardiac magnetic resonance (CMR) and assessed the impact of obesity. One hundred and fifty consecutive tertiary hypertension clinic referrals for CMR (1.5 T) were reviewed. Patients with cardiac pathology potentially confounding hypertensive LVH were excluded (
n
=22). The final sample size was 128 (age: 51.0±15.2 years, 48% male). LVH was defined by CMR. From a 12-lead ECG, Sokolow–Lyon voltage and product, Cornell voltage and product, Gubner–Ungerleidger voltage and Romhilt–Estes score were evaluated, blinded to the CMR. ECG diagnostic performance was calculated. LVH by CMR was present in 37% and obesity in 51%. Obesity significantly reduced ECG sensitivity, because of significant attenuation in mean ECG values for Cornell voltage (22.2±5.7 vs 26.4±9.4 mm,
P
<0.05), Cornell product (2540±942 vs 3023±1185 mm • ms,
P
<0.05) and for Gubner–Ungerleider voltage (18.2±7.1 vs 23.3±1.2 mm,
P
<0.05). Obesity also significantly reduced ECG specificity, because of significantly higher prevalence of LV remodeling (no LVH but increased mass-to-volume ratio) in obese subjects without LVH (36% vs 16%,
P
<0.05), which correlated with higher mean ECG LVH criteria values. Obesity-specific partition values were generated at fixed 95% specificity; Cornell voltage had highest sensitivity in non-obese (56%) and Sokolow–Lyon product in obese patients (24%). Obesity significantly lowers ECG sensitivity at detecting LVH, by attenuating ECG LVH values, and lowers ECG specificity through changes associated with LV remodeling. Our obesity-specific ECG partition values could improve the diagnostic performance in obese patients with hypertension.</description><subject>59/57</subject><subject>631/443/592/1540</subject><subject>692/499</subject><subject>692/699/75/243</subject><subject>Adult</subject><subject>Aged</subject><subject>Care and treatment</subject><subject>Diagnosis</subject><subject>Electrocardiography - standards</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health Administration</subject><subject>Heart enlargement</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertrophy, Left Ventricular - diagnostic imaging</subject><subject>Hypertrophy, Left Ventricular - etiology</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Original</subject><subject>original-article</subject><subject>Practice guidelines (Medicine)</subject><subject>Prospective Studies</subject><subject>Public Health</subject><subject>Risk factors</subject><subject>Two-dimensional echocardiography</subject><issn>0950-9240</issn><issn>1476-5527</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkl2L1DAUhoso7rh65b0EBBF0xrTNR-uFsCx-wYI3cx_S9KTNkCZj0g7MH_H3ms6M64wsSC4C533Oy8nJm2Uvc7zKcVl92PT9qsA5XdHqUbbICWdLSgv-OFvgmuJlXRB8lT2LcYPxLFZPs6uCYYIJwYvs17oHBFqDGpHXyDcQzbhH3iGwqRa8kqE1vgty2xuFWhhT1SQ5wf1-C2EEF80OkAU9oh24MRg1WRlOavDbfv8RBVDSmibIQ6_spHFxRAdvqdAgOwdjsg8QvZNOwfPsiZY2wovTfZ2tv3xe335b3v34-v325m6pGOHjUmpas7JN7yq0ZBWtgXBFedsoBrliXJcVV7yFBpoCly1TtKYAUipKWK1xeZ19Otpup2aAVs3jSyu2wQwy7IWXRlwqzvSi8ztBOMW4KJLB25NB8D8niKMYTFRgrXTgpyjyquYlr0mO_49ylobidcET-vofdOOn4NIiDlRecErLv1QnLQjjtE8jqtlU3BBScpJXJUvU6gEqnRYGo7wDbVL9ouHNWUMP0o599Haafy5egu-OoAo-xgD6fm85FnMyRUqmmJMpaJXoV-ervmf_RDEB749ATJLrIJw9-gG_3zNv8EM</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Rodrigues, J C L</creator><creator>McIntyre, B</creator><creator>Dastidar, A G</creator><creator>Lyen, S M</creator><creator>Ratcliffe, L E</creator><creator>Burchell, A E</creator><creator>Hart, E C</creator><creator>Bucciarelli-Ducci, C</creator><creator>Hamilton, M C K</creator><creator>Paton, J F R</creator><creator>Nightingale, A K</creator><creator>Manghat, N E</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7TS</scope><scope>5PM</scope></search><sort><creationdate>20160301</creationdate><title>The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance</title><author>Rodrigues, J C L ; McIntyre, B ; Dastidar, A G ; Lyen, S M ; Ratcliffe, L E ; Burchell, A E ; Hart, E C ; Bucciarelli-Ducci, C ; Hamilton, M C K ; Paton, J F R ; Nightingale, A K ; Manghat, N E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c647t-af5963d0142fa6859e47c57dbc6e1c67f387c7debeb203d6c595eeaac5469f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>59/57</topic><topic>631/443/592/1540</topic><topic>692/499</topic><topic>692/699/75/243</topic><topic>Adult</topic><topic>Aged</topic><topic>Care and treatment</topic><topic>Diagnosis</topic><topic>Electrocardiography - standards</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health Administration</topic><topic>Heart enlargement</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertrophy, Left Ventricular - diagnostic imaging</topic><topic>Hypertrophy, Left Ventricular - etiology</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Obesity</topic><topic>Obesity - complications</topic><topic>Original</topic><topic>original-article</topic><topic>Practice guidelines (Medicine)</topic><topic>Prospective Studies</topic><topic>Public Health</topic><topic>Risk factors</topic><topic>Two-dimensional echocardiography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodrigues, J C L</creatorcontrib><creatorcontrib>McIntyre, B</creatorcontrib><creatorcontrib>Dastidar, A G</creatorcontrib><creatorcontrib>Lyen, S M</creatorcontrib><creatorcontrib>Ratcliffe, L E</creatorcontrib><creatorcontrib>Burchell, A E</creatorcontrib><creatorcontrib>Hart, E C</creatorcontrib><creatorcontrib>Bucciarelli-Ducci, C</creatorcontrib><creatorcontrib>Hamilton, M C K</creatorcontrib><creatorcontrib>Paton, J F R</creatorcontrib><creatorcontrib>Nightingale, A K</creatorcontrib><creatorcontrib>Manghat, N E</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Physical Education Index</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of human hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodrigues, J C L</au><au>McIntyre, B</au><au>Dastidar, A G</au><au>Lyen, S M</au><au>Ratcliffe, L E</au><au>Burchell, A E</au><au>Hart, E C</au><au>Bucciarelli-Ducci, C</au><au>Hamilton, M C K</au><au>Paton, J F R</au><au>Nightingale, A K</au><au>Manghat, N E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance</atitle><jtitle>Journal of human hypertension</jtitle><stitle>J Hum Hypertens</stitle><addtitle>J Hum Hypertens</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>30</volume><issue>3</issue><spage>197</spage><epage>203</epage><pages>197-203</pages><issn>0950-9240</issn><eissn>1476-5527</eissn><abstract>Electrocardiograph (ECG) criteria for left ventricular hypertrophy (LVH) are a widely used clinical tool. We recalibrated six ECG criteria for LVH against gold-standard cardiac magnetic resonance (CMR) and assessed the impact of obesity. One hundred and fifty consecutive tertiary hypertension clinic referrals for CMR (1.5 T) were reviewed. Patients with cardiac pathology potentially confounding hypertensive LVH were excluded (
n
=22). The final sample size was 128 (age: 51.0±15.2 years, 48% male). LVH was defined by CMR. From a 12-lead ECG, Sokolow–Lyon voltage and product, Cornell voltage and product, Gubner–Ungerleidger voltage and Romhilt–Estes score were evaluated, blinded to the CMR. ECG diagnostic performance was calculated. LVH by CMR was present in 37% and obesity in 51%. Obesity significantly reduced ECG sensitivity, because of significant attenuation in mean ECG values for Cornell voltage (22.2±5.7 vs 26.4±9.4 mm,
P
<0.05), Cornell product (2540±942 vs 3023±1185 mm • ms,
P
<0.05) and for Gubner–Ungerleider voltage (18.2±7.1 vs 23.3±1.2 mm,
P
<0.05). Obesity also significantly reduced ECG specificity, because of significantly higher prevalence of LV remodeling (no LVH but increased mass-to-volume ratio) in obese subjects without LVH (36% vs 16%,
P
<0.05), which correlated with higher mean ECG LVH criteria values. Obesity-specific partition values were generated at fixed 95% specificity; Cornell voltage had highest sensitivity in non-obese (56%) and Sokolow–Lyon product in obese patients (24%). Obesity significantly lowers ECG sensitivity at detecting LVH, by attenuating ECG LVH values, and lowers ECG specificity through changes associated with LV remodeling. Our obesity-specific ECG partition values could improve the diagnostic performance in obese patients with hypertension.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>26040440</pmid><doi>10.1038/jhh.2015.58</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of human hypertension, 2016-03, Vol.30 (3), p.197-203 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | 59/57 631/443/592/1540 692/499 692/699/75/243 Adult Aged Care and treatment Diagnosis Electrocardiography - standards Epidemiology Female Health Administration Heart enlargement Humans Hypertension - complications Hypertrophy, Left Ventricular - diagnostic imaging Hypertrophy, Left Ventricular - etiology Magnetic Resonance Imaging Male Medicine Medicine & Public Health Middle Aged Obesity Obesity - complications Original original-article Practice guidelines (Medicine) Prospective Studies Public Health Risk factors Two-dimensional echocardiography |
| title | The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance |
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