[OP.7B.08] QRS VOLTAGE CORRECTION TO BODY MASS INDEX IN PREDICTING ALL CAUSE MORTALITY AND CARDIOVASCULAR EVENTS. THE MOLI-SANI STUDY

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Objective: Obesity reduces the accuracy and predictive value of voltage ECG criteria for left ventricular hypertrophy (LVH). Our aim was to investigate whether the correction to body mass index (BMI)might improve the prognostic significance for cardiovascular (CV) events of two different electrocardiographic (ECG) criteria for LVH in an adult Italian population at low risk CV risk. Design and method: 18330 adults (mean age 54 + 11 years, 55% women, 53% hypertensives)were analyzed from the Moli-sani cohort. Obesity was defined using the ATPIII criteria. ECG-LVH was defined according to the Sokolow-Lyon (SL) and Cornell Voltage (CV) criteria. Results: The age and sex adjusted prevalence of ECG-LVH did not differ from normal weight subjects to class 1–3 obesity subjects when the CV criterion was used. In overweight and obese patients, as compared with normal weight subjects, a progressively lower prevalence of ECG-LVH was observed when the SL index was used. During the follow-up, there were 503 new CV (216 coronary heart disease, 51 stroke and 307 heart failure; some individuals experienced more than one event). After adjusting for different confounders 1-SD increment in unadjusted and in BMI-corrected SL voltage was associated with an increased risk of CV events (HR 1.12, 95% CI 1.02 to 1.22 and HR 1.16, 95% CI 1.06 to 1.26, respectively);the same was true for unadjusted and for BMI-corrected CV (HR 1.12, 95% CI 1.03 to 1.23 and HR 1.17, 95% CI 1.07 to 1.27, respectively). The predictive significance of BMI-corrected SL and CV was assessed in obese subjects; after adjusting for confounders, the hazard ratio of CV events related to 1-SD increment of uncorrected CV was not significant and similar to the one conferred by the BMI corrected CV (HR 1.05, 95% CI 0.910–1.22 and HR 1.08, 95% CI 0.95–1.23, respectively). Uncorrected SL voltage showed a significant association with CV events, that was marginally stronger with BMI-corrected SL voltage (HR 1.18, 95% CI 1.02–1.37 and HR 1.17, 95% CI 1.04–1.33, respectively, Akaike information criterion change from 3220 to 3218). Conclusions: Our results show that BMI correction of CV and SL ECG criteria does not significantly improve the prediction of CV events in obese patients in a low cardiovascular risk cohort.

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