Electrocardiogram (ECG) Diagnosis of Left Ventricular Hypertrophy and its Associations in Patients Living with Diabetes

Abstract

Background: Macrovascular complications of diabetes mellitus (DM) include cardiac manifestations such as left ventricular hypertrophy (LVH), which can increase the risk of heart failure and death. Objectives: To determine associations between LVH and other variables in patients living with DM (PLWD). Methods: A retrospective study over 1 year was conducted on patients who attended the DM clinic at Edendale Hospital in South Africa. Electrocardiographs (ECGs) and standardised data sheets were analysed. The Sokolov–Lyon, Cornell and Romhilt–Estes methods were utilised for diagnosing LVH on ECGs. Results: There were 609 PLWD included in the study, with 80 PLWD (13.1%) having LVH (LVH+), whereas 529 PLWD (86.9%) had no LVH (LVH−). The Sokolov–Lyon method proved to be the best method of diagnosing LVH based on ECG (100% of patients diagnosed), with an ‘R wave in Augmented Vector Left (AVL) ≥11 mm’ being the best approach for determining LVH. LVH + patients were significantly younger than LVH − patients (27.22 years vs. 58.98 years, P < 0.001) and had lower systolic blood pressure (SBP) (118.62 mmHg vs. 139.77 mmHg, P < 0.001). Type 1 DM (DM1+) comprised the majority (77.5%) of LVH + patients. LVH + patients had significantly better high-density lipoproteins (1.36 mmol/L vs. 1.25 mmol/L, P = 0.024) and triglycerides (1.40 mmol/L vs. 1.85 mmol/L, P = 0.010) than LVH − patients. Conclusion: LVH was seen more frequently in younger patients who often had DM1+, lower SBP, higher HDL, and lower triglycerides. Most cases of LVH were diagnosed using the Sokolov–Lyon method. LVH should be screened for frequently in PLWD, irrespective of whether patients are hypertensive or not, and this should be done at all ages.