Novel Approach to the Detection of Left Ventricular Hypertrophy Using Body Mass Index-Corrected Electrocardiographic Voltage Criteria in a Group of African Ancestry.
BACKGROUND
Electrocardiographic (ECG) QRS voltages used to generate criteria for left ventricular hypertrophy (LVH) detection are considerably attenuated by obesity. This effect renders the utility of ECG criteria to detect LVH in obese individuals of African ancestry to be of limited value.


OBJECTIVE
A novel approach to correcting QRS voltages for the attenuating effect of body mass index (BMI) will improve the ability of ECG criteria to detect LVH in a group of African descent.


METHODS
Left ventricular mass was determined from echocardiography in 661 randomly selected participants (43.0% obese) of black African ancestry in South Africa.


RESULTS
As compared with Cornell and Sokolow-Lyon voltage criteria, BMI best correlated with RaVL , Gubner-Ungerleider, and Lewis QRS complex voltages, but these relations were noted only in those with BMI <29 kg/m(2) . Correcting RaVL and Lewis voltages by the difference in the slope of BMI-voltage relations in those with BMI <29 kg/m(2) vs those with BMI ≥29 kg/m(2) showed the greatest performance for LVH detection (uncorrected RaVL : 0.695 ± 0.025, corrected RaVL : 0.733 ± 0.022; P < 0.0001), and also increased the sensitivity (uncorrected RaVL : 30.6%, corrected RaVL : 42.4%; P < 0.0005) with no significant change in specificity (uncorrected RaVL : 86.3%, corrected RaVL : 83.0%; P = 0.28).


CONCLUSIONS
We offer a novel approach to correcting ECG voltages for the attenuating effects of obesity in individuals of African ancestry, and this improves the performance and sensitivity for LVH detection.
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Chanel
C
Robinson
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. angela.woodiwiss@wits.ac.za.
Angela J
AJ
Woodiwiss
School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Carlos D
CD
Libhaber
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Gavin R
GR
Norton
D000200:Action Potentials; D000328:Adult; D019540:Area Under Curve; D044383:Black People; D015992:Body Mass Index; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D013019:South Africa / Q000453:epidemiology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult