Electrocardiographic Signs of Left Ventricular Hypertrophy in Obese Patients: What Criteria Should be Used?
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EDITORIAL
Electrocardiographic Signs of Left Ventricular Hypertrophy in Obese Patients: What Criteria Should be Used? Giuseppe Germano
Received: 13 December 2013 / Accepted: 10 June 2014 Ó Springer International Publishing Switzerland 2014
Abstract Overweight and obesity are estimated at high prevalence and progression in adults; they are major contributors to chronic diseases and a major public health challenge. An obese habitus changes body-surface electrocardiograms (ECGs). Obesity is responsible for geometric changes to the heart and torso, as well as for deleterious electrophysiological changes of the heart. Common ECG changes, reduced voltages in the precordial leads, and axis deviation have made the search for left ventricular hypertrophy (LVH) even more problematic. Identification of LVH by ECG is difficult and time consuming but ECG is fundamental to reveal abnormalities of clinical relevance associated with obesity. The QTc dispersion assessment and the comparison with magnetic resonance imaging are the frontiers to clarify the connection between ECG LVH signs and overweight and obesity.
1 Introduction Hypertension guidelines [1, 2] recommend, as the first step of risk stratification, the 12-lead electrocardiographic identification of left ventricular hypertrophy (LVH), which represents a marker of cardiac organ damage and has been related to increased risk of cardiovascular morbidity and mortality at the population level as well as in different clinical conditions. Mechanical and hormonal stimuli may be involved in the activation of myocyte growth, increasing the risk of arrhythmias, impaired coronary flow reserve and
G. Germano (&) Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza University of Rome, Rome, Italy e-mail: [email protected]
decreased response of coronary flow to vasodilator management. The consequences of electrocardiographic electrogenesis can be summarized in: (1) a rotation of the heart around its three axes, anterior–posterior, longitudinal and transverse; (2) an increase in the voltage of the QRS prevalent in the leads that capture the potential of the enlarged ventricle; (3) increased QRS duration; its width increases from 0.0800 to 0.1000 ; (4) a delay in the onset of the intrinsicoid deflection in the precordial leads facing the enlarged ventricle: delay exceeding 0.0300 in the right precordial leads and 0.0500 in the left precordial leads [3]. Many features (up to 30) of LVH have been proposed (Table 1) [4], but the most widely used are based on a composition of voltage and non-voltage criteria including left ventricular strain, left atrial enlargement and the duration of intrinsicoid deflection (Table 2) [5]. The sensitivity of ECG criteria, when compared with the left ventricular mass by echocardiography is limited. David Pewsner’s review of 21 studies in different healthcare settings found that sensitivity ranged from 10.5 % for the Grubner index to 21 % for the Sokolow–Lyon index and that specificity ranged from 8
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