Rider Oliver J, Ntusi Ntobeko, Bull Sacha C, Nethononda Richard, Ferreira Vanessa, Holloway Cameron J, Holdsworth David, Mahmod Masliza, Rayner Jennifer J, Banerjee Rajarshi, Myerson Saul, Watkins Hugh, Neubauer Stefan
Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK.
Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK Division of Cardiology, Department of Medicine Research, University of Capetown, South Africa.
Heart. 2016 Oct 1;102(19):1566-72. doi: 10.1136/heartjnl-2015-309201. Epub 2016 Aug 2.
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.
Overall, 1295 participants were included-821 with a wide range of body mass index (BMI 17.1-53.3 kg/m(2)) 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/m(2)).
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%).
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.
心电图（ECG）是筛查左心室肥厚（LVH）最常用的工具，但在现代超重人群日益增多的社会中，目前的诊断标准并不敏感。我们提出一种简单的调整方法，以提高在不同体重情况下的诊断准确性，并提高这项普遍可用技术的敏感性。
总共纳入了1295名参与者，其中821名体重指数（BMI）范围广泛（17.1 - 53.3 kg/m²），他们最初接受了心脏磁共振对解剖学左心室（LV）轴、左心室质量和12导联体表心电图的评估，以生成应用于索科洛 - 里昂标准的调整因子。然后在第二个队列（n = 520，BMI 15.9 - 63.2 kg/m²）中对该因子进行验证。
当左心室质量匹配时，解剖学轴向左偏和BMI增加相结合导致索科洛 - 里昂指数降低，超重者降低4 mm，肥胖者降低8 mm。在初始队列中对此进行调整后，索科洛 - 里昂指数的敏感性增加（超重者：从12.8%增至30.8%，肥胖者：从3.1%增至27.2%），接近正常体重者的敏感性（37.8%）。在验证队列中也取得了类似结果（超重者特异性增加：从8.3%增至39.1%，肥胖者：从9.4%增至25.0%），同样接近正常体重者（39.0%）。重要的是，特异性仍然很高（>93.1%）。
根据BMI调整索科洛 - 里昂指数（超重者 +4 mm，肥胖者 +8 mm）可提高检测LVH的诊断准确性。由于在全球范围内，心电图仍然是用于LVH筛查的最广泛使用的工具，应用这些研究结果应能带来显著的临床益处。
