Prognostic significance of body mass index‐adjusted criteria for left ventricular hypertrophy

Electrocardiographic left ventricular hypertrophy (ECG‐LVH) is associated with both cardiovascular and all‐cause mortality. Obesity attenuates the sensitivity of several ECG‐LVH criteria, so body mass index (BMI) adjusted criteria have been developed. However, the prognostic significance of BMI‐adjusted ECG‐LVH criteria is not known. This analysis included 7812 participants (59.8 ± 13.4 years, 53% women, 50% non‐Hispanic‐whites) from the Third National Health and Nutrition Examination Survey. The Cornell criteria (R in aVL + S in V3 ≥ 2800 µV in men or ≥2200 µV in women) and Sokolow‐Lyon criteria (S in V1 + R in V5 or R in V6 ≥ 3500 µV) criteria were used for LVH. To account for the effects of obesity, the BMI‐adjusted Cornell criteria (product of R in aVL + S in V3 and BMI > 60 400 µV kg m −2 ) and the BMI‐adjusted Sokolow‐Lyon criteria (add 400 µV if overweight, add 800 µV if obese) were used. Compared to traditional ECG‐LVH criteria, more participants met criteria for ECG‐LVH with BMI‐adjusted Cornell voltage (9.9% vs 2.9%) and BMI‐adjusted Sokolow‐Lyon (13.1% vs 6.4%) criteria. In multivariable‐adjusted Cox proportional hazards models, the BMI‐adjusted Sokolow‐Lyon criteria performed no better than traditional criteria (HR 1.18, 95% CI 1.06‐1.32 for all‐cause, HR 1.38, 95% CI 1.17‐1.62 for cardiovascular mortality) and the BMI‐adjusted Cornell voltage criteria attenuated the association with all‐cause (HR 1.16, 95% CI 1.03‐1.32) and cardiovascular mortality (HR 1.34, 95% CI 1.13‐1.60). Despite potential improvements in the detection of LVH using BMI‐adjusted ECG‐LVH criteria, adjusting for BMI may result in the loss of prognostic information.