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

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.

A comparison of Cornell and Sokolow-Lyon electrocardiographic criteria for left ventricular hypertrophy in a military male population in Taiwan: the Cardiorespiratory fitness and HospItalization Events in armed Forces study

BACKGROUND

The Cornell and Sokolow-Lyon electrocardiography (ECG) criteria have been widely used for diagnosing left ventricular hypertrophy (LVH) in patients with hypertension. However, the correlations of these ECG criteria with LVH were rarely compared in military members who received rigorous training, particularly of the Asian male population.

METHODS

We compared the Cornell voltage and product criteria with the Sokolow-Lyon criteria for the echocardiographic LVH in 539 military male members, ages 18-50 years and free of hypertension in the Cardiorespiratory fitness and HospItalization Events in armed Forces (CHIEF) study in Taiwan. Pearson's correlation coefficient was used to determine the association of each ECG criterion with the index of left ventricular mass (LVM, g)/height (m)^2.7. The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the echocardiographic LVH which was defined as LVM index ≥49 g/m^2.7.

RESULTS

The correlations of the Cornell voltage and product criteria (r=0.24 and 0.26 respectively, both P<0.0001) were stronger than that of the Sokolow-Lyon criteria (r=0.049 and 0.095, and P=0.26 and 0.03 respectively) with the LVM index. Similarly the performances of the Cornell voltage and product criteria for the echocardiographic LVH [area under curve (AUC): 0.66 and 0.68, both P<0.0001] were superior to that of the Sokolow-Lyon criteria (AUC: 0.54 and 0.53, both P>0.1) in the area under the ROC curve analysis.

CONCLUSIONS

The Cornell ECG criteria for the echocardiographic LVH had better performance than the Sokolow-Lyon criteria in a young military male cohort in Taiwan.