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VOLUME 12 NUMBER 2 • NOVEMBER 2015
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
final study population consisting of 148 type 2 and 89 type 1
diabetics, type 2 patients were significantly older (
p
< 0.001), had
longer duration of diabetes (
p
< 0.05), higher body mass index (
p
< 0.001), waist circumference and waist-hip ratio (
p
< 0.001), and
included more patients with hypertension (Table 1).
Prevalence of ECG-LVH
In the total study population, 37 (15.6%) patients had LVH by either
Sokolow-Lyon or Cornell product criteria. The prevalence of ECG-
LVH by the Sokolow-Lyon criterion was 12.2% of patients in the
total study population, and by the Cornell product criterion 5.1%.
The prevalence of LVH by any criteria did not differ between type 1
and type 2 patients (15.7 vs 15.5%, ns) (Table 1).
All type 1 patients with LVH were identified by the Sokolow-Lyon
voltage criterion. Among the 23 type 2 diabetic patients with ECG-
LVH, 12 were identified by the Cornell voltage product criterion
and 15 by the Sokolow-Lyon voltage criterion. Four patients were
identified by both criteria. Sixteen (44.4%) hypertensive patients
and 11 (29.7%) patients with albuminuria had ECG-LVH identified
by either the Cornell voltage product criterion or the Sokolow-Lyon
voltage criterion.
Covariates of ECG-LVH
Type 2 patients with ECG-LVH by either criterion had significantly
higher systolic and mean BP than patients without ECG-LVH
(Table 2). There were, however, no differences between all the
covariates in type 1 patients with or without ECG-LVH. In logistic
regression analysis in type 2 patients of both genders, with
diabetes type, age, diabetes duration, waist circumference, systolic
and diastolic BP and albuminuria as the independent variables,
ECG-LVH was associated with albuminuria [OR 4.046 (95% CI,
1.517−10.796),
p
< 0.01], and higher systolic BP [OR 1.534 per
10 mmHg higher SBP (95%CI, 1.081−2.176),
p
< 0.01] in univariate
analysis.
Including the significant variables in a multivariate model, systolic
BP was the only independent risk factor for ECG-LVH. The risk of
Table 1.
Demographic characteristics and the ECG findings in the study
population divided by type of diabetes
Type 1
Type 2
Variables
diabetes
diabetes
Number (%)
89 (37.6)
148 (62.4)
Age at inclusion (years)
20.8 (4−45) 51.8 (23.5−85)***
Women,
n
(%)
44 (49.4)
83 (56.1)
Diabetes duration (years)
3.0(0−17)
4 (0−25)*
Smoking,
n
(%)
Current smoker
2 (2.4)
4 (2.7)
Ex-smoker
1 (1.2)
25 (17)
Never smoked
82 (96.5)
118 (80.3)
BMI (kg/m
2
)
19.4 (3.9)
27.8 (4.7)***
Waist circumference (cm)
70.3 (13.2)
94.2 (14.5)***
Waist−hip ratio (cm)
0.86 (0.73)
0.94 (0.11)***
Proportion with hypertension,
n
(%)
9 (11.7)
78 (54.2)***
ECG findings
Any LVH criteria
14 (15.7)
23 (15.5)
Sokolow-Lyon voltage LVH
14 (15.7)
15 (10.1)
Cornell voltage-duration product LVH
0
12 (8.1)**
T-wave inversion
30 (33.7)
38 (25.7)
ST abnormality
13 (14.6)
18 (12.2)
Intraventricular conduction defects
8 (9.0)
38 (26)***
Data expressed as median (min−max) and mean (SD) as appropriate.
*
p
< 0.05, **
p
< 0.01, ***
p
< 0.001.
Table 2.
Cardiovascular risk factors and biochemical characteristics in study patients with and without ECG-LVH
Type 1 diabetes
Type 2 diabetes
Variables
No LVH
LVH by any criteria
No LVH
LVH by any criteria
Basic characteristics
n
(%)
75 (84.3)
14 (15.7)
125 (84.5)
23 (15.5)
Women,
n
(%)
38 (86.4)
6 (13.6)
70 (84.3)
13 (15.7)
Body mass index (kg/m
2
)
19.5 (4.1)
19.4 (2.5)
27.9 (4.6)
27.7 (5.4)
Waist circumference (cm)
69.7 (14)
74 (6.4)
95.1 (12.3)
94 (12.4)
Proportion with abdominal obesity
n
(%)
38 (88.4)
5 (11.6)
31 (93.9)
2 (6.1)
Blood pressure
Systolic BP (mmHg)
103 (72−140)
110 (100−140)
134 (98−210)
150 (90−200)*
Diastolic BP (mmHg)
73 (50−110)
78 (50−83)
84 (60−120)
86 (68−136)
Mean BP (mmHg)
84 (12)
88 (8)
102 (15)
110 (20)*
Pulse pressure (mmHg)
35 (9)
41 (17)
53 (16)
61 (22)
Proportion with hypertension,
n
(%)
7 (77.8.)
2 (22.2)
59 (81.9)
13 (18.1)
Heart rate (bpm)
83 (17)
82 (15)
76 (15)
78 (10)
Biochemistry
Total cholesterol (mmol/l)
4.4 (1.3)
4.6 (0.7)
5.15 (1.3)
5.4 (1.2)
HDL cholesterol (mmol/l)
1.2 (0.4)
1.2 (0.3)
1.2 (0.44)
1.24 (0.42)
LDL cholesterol (mmol/l)
2.5 (1.03)
2.7 (0.8)
3.1 (1.1)
3.3 (1.0)
Serum triglycerides (mmol/l)
1.5 (1.3)
1.6 (1.7)
1.5 (0.9)
1.4 (1.3)
Serum creatinine (mmol/l)
48.3 (14)
51 (14)
74 (25)
79.4 (30)
Creatinine clearance (ml/min)
129 (46.4−482)
138 (74.7−206.9)
106 (39.6−273.4)
96.5 (49.6−178.5)
Albumin excretion rate (μg/min)
5.8 (0.7−290)
4.98 (1.44−91)
4.96 (1.3−2000)
4.85 (2.3−2000)
Proportion with albuminuria,
n
(%)
9 (82)
2 (18)
17 (65.4)
9 (34.6)
HbA
1c
(%)
14 (6.3− > 14)
13.8 (8.6− > 14)
9.9 (4.4− > 14)
8.0 (5.4− > 14)
Other ECG findings
IVC defects,
n
(%)
7 (87.5)
1 (12.5)
31 (81.6)
7 (18.4)
ST abnormalities,
n
(%)
8 (61.5)
5 (38.5)
13 (72.2)
5 (27.8)
T-wave inversion,
n
(%)
24 (80)
6 (20)
19 (76.3)
9 (23.7)
Data expressed as median (min−max) and mean (SD) as appropriate. *
p
< 0.05, **
p
< 0.01, ***
p
< 0.001.