The SA Journal Diabetes & Vascular Disease Vol 12 No 2 (December 2015)

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VOLUME 12 NUMBER 2 • NOVEMBER 2015 77
SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE
In the current study, the prevalence of ECG-LVH was higher in
type 2 diabetic patients with albuminuria than in normalbuminuric
patients. Furthermore, the prevalence of ECG-LVH was also higher
in hypertensive patients with albuminuria compared to hypertensive
patients without albuminuria. The present study adds to previous
knowledge by demonstrating a relationship between LVH,
hypertension and albuminuria after a short duration of diabetes in
Tanzanian type 2 diabetes patients. In the LIFE study, ECG-LVH using
Cornell product or by Sokolow-Lyon criteria was associated with a
1.6-fold increase in the prevalence of microalbuminuria and a 2.6-
fold increase in the prevalence of macroalbuminuria compared to
those without LVH.10
In our study, ST-segment depression and T-wave inversion
on ECG were associated with having ECG-LVH. The finding is in
accordance with previous reports in hypertensive patients, finding
strain patterns in the absence of coronary disease to indicate
the presence of anatomical LVH.37,38 But such ECG findings can
also indicate myocardial injury.7,37 However, in the present study
population, there were no patients reporting clinical symptoms
suggestive of coronary heart disease.
The median HbA1c levels were high in both types of diabetics,
indicating poor metabolic control. However, there was no
correlation between HbA1c and LVH in this study. Use of the Cornell
product and Sokolow Lyon voltage criteria to diagnose ECGLVH
has been validated in large studies. However, the accuracy of the
criteria used for detecting LVH has been found to vary with body
size and gender. For instance, obesity decreased the sensitivity of
the Sokolow-Lyon voltage ECG criterion38 and it was more sensitive
in men, while the Cornell product criterion had greater sensitivity
with women.33
Therefore, in the current population, these ECG criteria only
partially identified different diabetic patients. Our findings are in
agreements with previous reports from the LIFE study33 in which the
above ECG criteria set for LVH also identified different hypertensive
patients with different baseline characteristics. This finding further
emphasises the importance of using more than a single criterion to
more correctly diagnose patients with ECG-LVH.
Study limitation
The major limitation of this study was that echocardiography was
not performed to confirm anatomical LVH in patients with ECG-
LVH. We chose ECG for diagnosing LVH because it is a more widely
available, cheaper and more easily performed technique, albeit less
sensitive and specific than echocardiography, for detection of LVH,
in particular within African populations and in young or thin type
1 diabetic patients. However, previous publications from the LIFE
study have documented that the majority of patients with ECG-LVH
with the criteria used in our study indeed also had LVH detected
by echocardiography.33 As the present study did not include a
non-diabetic comparative group, the impact of diabetes alone on
prevalence of ECG-LVH in the Tanzanian population could not be
determined.
Conclusion
This study demonstrates that ECG-LVH was present in 15.7% of
type 1 and 15.5% of type 2 diabetic Tanzanian patients. Systolic
BP and albuminuria were identified as the main predictors of the
presence of ECG-LVH. Our study also demonstrated that CV risk
factors cluster in type 2 diabetics, underscoring the need for broad
screening of CV risk factors in these patients to optimise prevention
of CV risk complications.
Acknowledgements
The study was supported in part by Novo Nordisk Scandinavia
A/S, Oslo, Wyeth Lederle Norge, Oslo, and the Diabetes Research
Foundation, Department of Medicine, Haraldsplass Deaconal
Hospital, Bergen, Norway.
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