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Relating QRS voltages to left ventricular mass and body composition in elite endurance athletes. Eur J Appl Physiol 2023; 123:547-559. [PMID: 36376599 DOI: 10.1007/s00421-022-05080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Electrocardiogram (ECG) QRS voltages correlate poorly with left ventricular mass (LVM). Body composition explains some of the QRS voltage variability. The relation between QRS voltages, LVM and body composition in endurance athletes is unknown. METHODS Elite endurance athletes from the Pro@Heart trial were evaluated with 12-lead ECG for Cornell and Sokolow-Lyon voltage and product. Cardiac magnetic resonance imaging assessed LVM. Dual energy x-ray absorptiometry assessed fat mass (FM) and lean mass of the trunk and whole body (LBM). The determinants of QRS voltages and LVM were identified by multivariable linear regression. Models combining ECG, demographics, DEXA and exercise capacity to predict LVM were developed. RESULTS In 122 athletes (19 years, 71.3% male) LVM was a determinant of the Sokolow-Lyon voltage and product (β = 0.334 and 0.477, p < 0.001) but not of the Cornell criteria. FM of the trunk (β = - 0.186 and - 0.180, p < 0.05) negatively influenced the Cornell voltage and product but not the Sokolow-Lyon criteria. DEXA marginally improved the prediction of LVM by ECG (r = 0.773 vs 0.510, p < 0.001; RMSE = 18.9 ± 13.8 vs 25.5 ± 18.7 g, p > 0.05) with LBM as the strongest predictor (β = 0.664, p < 0.001). DEXA did not improve the prediction of LVM by ECG and demographics combined and LVM was best predicted by including VO2max (r = 0.845, RMSE = 15.9 ± 11.6 g). CONCLUSION LVM correlates poorly with QRS voltages with adipose tissue as a minor determinant in elite endurance athletes. LBM is the strongest single predictor of LVM but only marginally improves LVM prediction beyond ECG variables. In endurance athletes, LVM is best predicted by combining ECG, demographics and VO2max.
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Haan YC, Diemer FS, Van Der Woude L, Van Montfrans GA, Oehlers GP, Brewster LM. The risk of hypertension and cardiovascular disease in women with uterine fibroids. J Clin Hypertens (Greenwich) 2018; 20:718-726. [PMID: 29569360 DOI: 10.1111/jch.13253] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/28/2017] [Accepted: 01/01/2018] [Indexed: 11/28/2022]
Abstract
Women with fibroids have a notably high hypertension risk. However, adjusted data regarding other cardiovascular disease (CVD) risk factors are scarce. In this cross-sectional study, CVD risk factors, hemodynamic parameters, and asymptomatic organ damage were analyzed between women with uterine fibroids and controls in a multi-ethnic population. In total, 104 women with self-reported fibroids and 624 controls were included. Women with fibroids had significantly higher odds to have hypertension (OR 3.4; 95% CI 2.2-5.2), diabetes (1.7; 1.0-2.9), and hypercholesterolemia (1.8; 1.1-3.2). After adjustment for confounders, only the odds ratio for hypertension was significant (1.8; 1.1-3.1). Asymptomatic organ damage occurred significantly more often in women with fibroids (66.7%; 95% CI 55.8%-77.6% vs 42.9%; 38.0-47.8 in controls), especially in the younger age group (respectively 48.5%; 31.1%-65.9% vs 22.1%; 17.0-27.2). In this study, women with fibroids had a remarkably high hypertension risk compared to controls, with more asymptomatic organ damage, in particular young women.
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Affiliation(s)
- Yentl C Haan
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederieke S Diemer
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Lisa Van Der Woude
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Gert A Van Montfrans
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Glenn P Oehlers
- Department of Cardiology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Lizzy M Brewster
- Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Public Health, Anton de Kom University of Suriname, Paramaribo, Suriname
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Kurisu S, Ikenaga H, Watanabe N, Higaki T, Shimonaga T, Ishibashi K, Dohi Y, Fukuda Y, Kihara Y. Implications of World Health Organization classification for body mass index on the correlations between common electrocardiographic indexes for left ventricular hypertrophy and left ventricular mass. Clin Exp Hypertens 2016; 38:715-720. [PMID: 27936957 DOI: 10.1080/10641963.2016.1200604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Some electrocardiographic indexes such as Cornell index, Cornell product index, or Sokolow-Lyon index remain to be used in the clinical setting. We assessed the effects of body mass index (BMI) on the correlations between these ECG indexes and left ventricular mass (LVM). METHODS One hundred ninety-six outpatients who underwent both ECG and echocardiography on the same day were included in this study. In accordance with the World Health Organization (WHO) classification of BMI, the patients were classified into the four groups: underweight (<18.5 kg/m2, n = 30), normal weight (18.5-24.9 kg/m2, n = 83), overweight (25-29.9 kg/m2, n = 43), and obese (≥30 kg/m2, n = 40). RESULTS With increasing WHO classification of BMI, Cornell index (RaVL+SV3), Cornell product index [(RaVL+SV3)RQRS duration], and LVM increased. On the other hand, Sokolow-Lyon index (SV1+RV5) decreased. Cornell index correlated with LVM in normal weight group (r = 0.27, p = 0.015), but did not in the other groups. Cornell product index also correlated with LVM in normal weight group (r = 0.30, p = 0.006), but did not in the other groups. Sokolow-Lyon index correlated with LVM well in normal weight group (r = 0.32, p = 0.004) and better in underweight group (r = 0.61, p = 0.0004). However, no correlations were found in overweight and obese groups. CONCLUSIONS Our results suggest that BMI influences the correlations between these ECG indexes and LVM, and should be taken into consideration when assessing LVH.
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Affiliation(s)
- Satoshi Kurisu
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Hiroki Ikenaga
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Noriaki Watanabe
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Tadanao Higaki
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Takashi Shimonaga
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Ken Ishibashi
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yoshihiro Dohi
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yukihiro Fukuda
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yasuki Kihara
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
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Robinson C, Woodiwiss AJ, Libhaber CD, Norton GR. Novel Approach to the Detection of Left Ventricular Hypertrophy Using Body Mass Index-Corrected Electrocardiographic Voltage Criteria in a Group of African Ancestry. Clin Cardiol 2016; 39:524-30. [PMID: 27279262 DOI: 10.1002/clc.22560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/02/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Electrocardiographic (ECG) QRS voltages used to generate criteria for left ventricular hypertrophy (LVH) detection are considerably attenuated by obesity. This effect renders the utility of ECG criteria to detect LVH in obese individuals of African ancestry to be of limited value. HYPOTHESIS A novel approach to correcting QRS voltages for the attenuating effect of body mass index (BMI) will improve the ability of ECG criteria to detect LVH in a group of African descent. METHODS Left ventricular mass was determined from echocardiography in 661 randomly selected participants (43.0% obese) of black African ancestry in South Africa. RESULTS As compared with Cornell and Sokolow-Lyon voltage criteria, BMI best correlated with RaVL , Gubner-Ungerleider, and Lewis QRS complex voltages, but these relations were noted only in those with BMI <29 kg/m(2) . Correcting RaVL and Lewis voltages by the difference in the slope of BMI-voltage relations in those with BMI <29 kg/m(2) vs those with BMI ≥29 kg/m(2) showed the greatest performance for LVH detection (uncorrected RaVL : 0.695 ± 0.025, corrected RaVL : 0.733 ± 0.022; P < 0.0001), and also increased the sensitivity (uncorrected RaVL : 30.6%, corrected RaVL : 42.4%; P < 0.0005) with no significant change in specificity (uncorrected RaVL : 86.3%, corrected RaVL : 83.0%; P = 0.28). CONCLUSIONS We offer a novel approach to correcting ECG voltages for the attenuating effects of obesity in individuals of African ancestry, and this improves the performance and sensitivity for LVH detection.
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Affiliation(s)
- Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Carlos D Libhaber
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cuspidi C, Facchetti R, Bombelli M, Sala C, Tadic M, Grassi G, Mancia G. Does QRS Voltage Correction by Body Mass Index Improve the Accuracy of Electrocardiography in Detecting Left Ventricular Hypertrophy and Predicting Cardiovascular Events in a General Population? J Clin Hypertens (Greenwich) 2016; 18:415-21. [PMID: 26395327 PMCID: PMC8031592 DOI: 10.1111/jch.12678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Abstract
The authors assessed the value of body mass index (BMI) correction of two electrocardiographic criteria in improving detection of left ventricular hypertrophy (LVH) and prediction of cardiovascular and all-cause mortality in the Italian study Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population. At entry, 1549 patients underwent diagnostic tests, 24-hour ambulatory blood pressure (BP) monitoring, standard electrocardiography, and echocardiography. The BMI-corrected Cornell voltage and Sokolow-Lyon voltage criteria provided better results for detection of echocardiographic LVH as compared with unadjusted electrocardiographic parameters. Cornell voltage index, but not Sokolow-Lyon index, was associated with an increased risk of cardiovascular events (and all-cause mortality). The adjusted risk of cardiovascular events related to one-standard deviation increment of BMI-corrected Cornell voltage was similar to that conferred by the uncorrected criterion in the total population, but outperformed in obese participants. These findings show that correction for BMI may improve the diagnostic accuracy of Cornell voltage index in detecting LVH and prediction of cardiovascular mortality in obese individuals.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
- Istituto Auxologico Italiano IRCCSMilanoItaly
| | - Rita Facchetti
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
| | - Michele Bombelli
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
| | - Carla Sala
- Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore PoliclinicoMilanoItaly
| | - Marijana Tadic
- University Clinical Hospital Centre “Dragisa Misovic”BelgradeSerbia
| | - Guido Grassi
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
- IRCCS MultimedicaMilanoItaly
| | - Giuseppe Mancia
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
- Istituto Auxologico Italiano IRCCSMilanoItaly
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Germano G. Electrocardiographic Signs of Left Ventricular Hypertrophy in Obese Patients: What Criteria Should be Used? High Blood Press Cardiovasc Prev 2014; 22:5-9. [DOI: 10.1007/s40292-014-0062-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/10/2014] [Indexed: 11/30/2022] Open
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Maunganidze F, Woodiwiss AJ, Libhaber CD, Maseko MJ, Majane OHI, Norton GR. Left ventricular hypertrophy detection from simple clinical measures combined with electrocardiographic criteria in a group of African ancestry. Clin Res Cardiol 2014; 103:921-9. [DOI: 10.1007/s00392-014-0730-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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Weinsaft JW, Kochav JD, Kim J, Gurevich S, Volo SC, Afroz A, Petashnick M, Kim A, Devereux RB, Okin PM. P wave area for quantitative electrocardiographic assessment of left atrial remodeling. PLoS One 2014; 9:e99178. [PMID: 24901435 PMCID: PMC4047099 DOI: 10.1371/journal.pone.0099178] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/12/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left atrial (LA) dilation provides a substrate for mitral regurgitation (MR) and atrial arrhythmias. ECG can screen for LA dilation but standard approaches do not assess LA geometry as a continuum, as does non-invasive imaging. This study tested ECG-quantified P wave area as an index of LA geometry. METHODS AND RESULTS 342 patients with CAD underwent ECG and CMR within 7 (0.1±1.4) days. LA area on CMR correlated best with P wave area in ECG lead V1 (r = 0.42, p<0.001), with lesser correlations for P wave amplitude and duration. P wave area increased stepwise in relation to CMR-evidenced MR severity (p<0.001), with similar results for MR on echocardiography (performed in 86% of patients). Pulmonary arterial (PA) pressure on echo was increased by 50% among patients in the highest (45±14 mmHg) vs. the lowest (31±9 mmHg) P wave area quartile of the population. In multivariate regression, CMR and echo-specific models demonstrated P wave area to be independently associated with LA size after controlling for MR, as well as echo-evidenced PA pressure. Clinical follow-up (mean 2.4±1.9 years) demonstrated ECG and CMR to yield similar results for stratification of arrhythmic risk, with a 2.6-fold increase in risk for atrial fibrillation/flutter among patients in the top P wave area quartile of the population (CI 1.1-5.9, p = 0.02), and a 3.2-fold increase among patients in the top LA area quartile (CI 1.4-7.0, p = 0.005). CONCLUSIONS ECG-quantified P wave area provides an index of LA remodeling that parallels CMR-evidenced LA chamber geometry, and provides similar predictive value for stratification of atrial arrhythmic risk.
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Affiliation(s)
- Jonathan W. Weinsaft
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Radiology, Weill Cornell Medical College, New York, New York, United States of America
- Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States of America
| | - Jonathan D. Kochav
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jiwon Kim
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States of America
| | - Sergey Gurevich
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Samuel C. Volo
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Anika Afroz
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Maya Petashnick
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Agnes Kim
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Richard B. Devereux
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Peter M. Okin
- Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
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The difficult art of detecting left ventricular hypertrophy in obesity. J Hypertens 2013; 31:1272. [DOI: 10.1097/hjh.0b013e3283610518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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