Maunganidze F., Woodiwiss A.J., Libhaber C.D., Maseko M.J., Majane O.H.I., Norton G.R.
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa; School of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Maunganidze, F., Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa; Woodiwiss, A.J., Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa; Libhaber, C.D., Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa, School of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Maseko, M.J., Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa; Majane, O.H.I., Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa; Norton, G.R., Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa
Aim: To assess the impact of obesity on the validity and performance of electrocardiographic criteria for the detection of left ventricular hypertrophy (LVH) in a group of participants of black African ancestry with a high prevalence of obesity. Methods: Electrocardiographic voltage criteria for the detection of echocardiographic LVH [left ventricular mass index (LVMI) >51 g/m] were evaluated in 661 participants from a community sample of black African ancestry (43% obese). Results: BMI was inversely associated with Sokolow-Lyon voltages (partial r =-0.27, P < 0.0001) and no BMI-Cornell voltage relations were noted (P = 0.21). BMI was associated with voltage criteria that incorporate only limb lead recordings (r = 0.17-0.23), but these relations were weaker than BMI-LVMI relations (r = 0.36, P < 0.01 and P < 0.0001 for comparisons of r values). All electrocardiographic criteria were as strongly related to blood pressure as LVMI. Sokolow-Lyon voltage-LVMI relations were noted only after adjustments for BMI (P < 0.02) and Sokolow-Lyon voltages showed no performance for LVH detection. Cornell voltages showed significant performance in nonobese [area under receiver operating curve (AUC) = 0.67 ± 0.04, P < 0.0005], but not in obese (AUC = 0.56 ± 0.04, P = 0.08). Electrocardiographic criteria which employ limb-lead recordings only (e.g. RaVL) showed better performance in nonobese than in obese (AUC = 0.75 ± 0.04 and 0.59 ± 0.04, respectively, P < 0.005 for comparison) and markedly reduced specificity for LVH detection in obese (76%) than in nonobese (92%, P < 0.0001) despite similar sensitivities (32 vs. 29%). Conclusion: In groups of black African ancestry, obesity contributes to a poor validity and performance of all voltage criteria for the detection of LVH. None of the current criteria are recommended for use in obesity. © 2013 Wolters Kluwer Health | Lippincott Williams Wilkins.