TY - JOUR T1 - Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity JF - Heart JO - Heart SP - 1566 LP - 1572 DO - 10.1136/heartjnl-2015-309201 VL - 102 IS - 19 AU - Oliver J Rider AU - Ntobeko Ntusi AU - Sacha C Bull AU - Richard Nethononda AU - Vanessa Ferreira AU - Cameron J Holloway AU - David Holdsworth AU - Masliza Mahmod AU - Jennifer J Rayner AU - Rajarshi Banerjee AU - Saul Myerson AU - Hugh Watkins AU - Stefan Neubauer Y1 - 2016/10/01 UR - http://heart.bmj.com/content/102/19/1566.abstract N2 - Objectives The electrocardiogram (ECG) is the most commonly used tool to screen for left ventricular hypertrophy (LVH), and yet current diagnostic criteria are insensitive in modern increasingly overweight society. We propose a simple adjustment to improve diagnostic accuracy in different body weights and improve the sensitivity of this universally available technique.Methods Overall, 1295 participants were included—821 with a wide range of body mass index (BMI 17.1–53.3 kg/m2) initially underwent cardiac magnetic resonance evaluation of anatomical left ventricular (LV) axis, LV mass and 12-lead surface ECG in order to generate an adjustment factor applied to the Sokolow–Lyon criteria. This factor was then validated in a second cohort (n=520, BMI 15.9–63.2 kg/m2).Results When matched for LV mass, the combination of leftward anatomical axis deviation and increased BMI resulted in a reduction of the Sokolow–Lyon index, by 4 mm in overweight and 8 mm in obesity. After adjusting for this in the initial cohort, the sensitivity of the Sokolow–Lyon index increased (overweight: 12.8% to 30.8%, obese: 3.1% to 27.2%) approaching that seen in normal weight (37.8%). Similar results were achieved in the validation cohort (specificity increased in overweight: 8.3% to 39.1%, obese: 9.4% to 25.0%) again approaching normal weight (39.0%). Importantly, specificity remained excellent (>93.1%).Conclusions Adjusting the Sokolow–Lyon index for BMI (overweight +4 mm, obesity +8 mm) improves the diagnostic accuracy for detecting LVH. As the ECG, worldwide, remains the most widely used screening tool for LVH, implementing these findings should translate into significant clinical benefit. ER -