Diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy among various body mass index groups compared to diagnosis by cardiac magnetic resonance imaging

BACKGROUND: Presence of left ventricular hypertrophy (LVH) increases the risk for cardiovascular event. Many electrocardiographic (ECG) criteria can be used to diagnose LVH; however, high body mass index (BMI) may reduce ECG amplitudes.The aim of this study was to investigate the diagnostic performance of ECG criteria for diagnosing LVH among various BMI groups compared to diagnosis by cardiac magnetic resonance (CMR) imaging. METHODS: Patients who were referred for CMR were enrolled. CMR and ECG were performed on the same day. Left ventricular function, volume, and mass were calculated from CMR. Standard ECG criteria were measured, including: Cornell voltage, Cornell product, Romhilt-Estes point score system, Sokolow-Lyon index, and Sokolow-Lyon-Rappaport index. Diagnostic performance of each ECG criterion was calculated and analyzed in the following four BMI groups: underweight (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23-24.9 kg/m2 ), and obese (≥25 kg/m2 ). RESULTS: Of the 1,882 patients that were included, 67 were underweight, 459 were normal weight, 434 were overweight, and 922 were obese. LVH was diagnosed in 34 (50.7%) underweight, 144 (31.4%) normal weight, 100 (23.0%) overweight, and 181 (19.6%) obese patients. Overall specificity of ECG was high (0.89-0.95), and overall sensitivity was low (0.25-0.37). The specificity of each ECG criterion was similar among BMI groups; however, the sensitivity of ECG criteria demonstrated a decreasing trend in the higher BMI groups. CONCLUSION: All ECG criteria demonstrated relatively high specificity and relatively low sensitivity. Although the specificity across groups remained similar, higher BMI was found to be associated with decreased sensitivity.