Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community

Abstract

BackgroundLeft ventricular hypertrophy (LVH) is a strong predictor of cardiovascular disease and is common among patients with type 2 diabetes. However, no systematic screening for LVH is currently recommended for patients with type 2 diabetes. The purpose of this study was to determine whether NT-proBNP was superior to 12-lead electrocardiography (ECG) for detection of LVH in patients with type 2 diabetes.MethodsProspective cross-sectional study comparing diagnostic accuracy of ECG and NT-proBNP for the detection of LVH among patients with type 2 diabetes. Inclusion criteria included having been diagnosed for > 5 years and/or on treatment for type 2 diabetes; patients with Stage 3/4 chronic kidney disease and known cardiovascular disease were excluded. ECG LVH was defined as either the Sokolow-Lyon or Cornell voltage criteria. NT-proBNP level was measured using the Roche Diagnostics Elecsys assay. Left ventricular mass was assessed from echocardiography. Receiver operating characteristic curve analysis was carried out and area under the curve (AUC) was calculated.Results294 patients with type 2 diabetes were recruited, mean age 58 (SD 11) years, BP 134/81 ± 18/11 mmHg, HbA1c 7.3 ± 1.5%. LVH was present in 164 patients (56%). In a logistic regression model age, gender, BMI and a history of hypertension were important determinants of LVH (p < 0.05). Only 5 patients with LVH were detected by either ECG voltage criteria. The AUC for NT-proBNP in detecting LVH was 0.68.ConclusionsLVH was highly prevalent in asymptomatic patients with type 2 diabetes. ECG was an inadequate test to identify LVH and while NT-proBNP was superior to ECG it remained unsuitable for detecting LVH. Thus, there remains a need for a screening tool to detect LVH in primary care patients with type 2 diabetes to enhance risk stratification and management.

RETRACTED ARTICLE: Troxerutin reverses fibrotic changes in the myocardium of high-fat high-fructose diet-fed mice

“…ECG data can give information on LVH, and are useful to understand cardiac dysfunction and heart disease [29]. ECG observations from our study revealed R-wave enlargement, development of Q waves, prolonged QT interval, and ST segment depression in HFFD-fed mice.…”

Electrocardiographic Left Ventricular Hypertrophy Among Gambian Diabetes Mellitus Patients

“…12 Generally, black individuals have greater precordial QRS voltages than whites and many of the LVH criteria have higher sensitivity in detecting LVH in blacks and lower specificity compared with whites. 13,14 However, many of the criteria proposed like the Araoye for African blacks are yet to be validated and so far have offered no comparative advantage over the standard criteria.…”

Role of Vitamin D in Cardiovascular Diseases

“…Further, LVH and cardiomyopathy in Fabry’s disease have been attributed to vitamin D deficiency due to less exposure to sunlight [29]. Diabetes, a chronic inflammatory disease, is a risk factor for LVH [30]. Reversal of LVH in diabetic rats [31] and attenuation of TNF-α expression by inhibition of nuclear factor-kappa beta (NF-κB/p65) signaling in hypertrophied rat hearts with vitamin D [32] suggest the role of vitamin D in reversal of LVH.…”