Influence of obesity on the diagnostic value of electrocardiographic criteria for detecting left ventricular hypertrophy

Easily applicable, clinically relevant electrocardiographic criteria are needed to screen large populations for left ventricular (LV) hypertrophy. The aim of this study was to evaluate, in a population of 380 hypertensive patients of both sexes, whether obesity modified the diagnostic performance of Sokolow-Lyon and Cornell voltage criteria by comparing them with echocardiographic evaluations using different indexation methods for LV mass presentation (body surface area and various powers of the height variable). For the population as a whole, Cornell voltage was better correlated to LV mass than was Sokolow-Lyon voltage (r = 0.48 and 0.36, respectively). The poorest performance of Sokolow-Lyon voltage was observed among obese patients (best r = 0.1 and 0.21 in obese women and men, respectively). Sensitivities were assessed at a 95% specificity level. nonobese patients, using sex-adjusted voltage values (43 and 36 mm in men and women, respectively, for Sokolow-Lyon voltage, and 28 and 25 mm for Cornell voltage), the sensitivities of Cornell voltage and Sokolow-lyon voltage were similar in men and women (near 22% and 36%, respectively), whatever the indexation method used for LV mass. In obese patients, Cornell voltage sensitivity was similar to that of nonobese patients, whereas Sokolow-Lyon voltage had a much poorer sensitivity (<10%). For simple LV hypertrophy detection criteria, Sokolow-Lyon voltage should be avoided in obese hypertensive patients and replaced by the Cornell voltage criteria, which are not influenced by the presence of obesity.