Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community
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Authors
Whalley, Gillian
Somaratne, Jithendra B.
Poppe, K.K.
ter Bals, M.M.
Wadams, Gina
Pearl, Ann
Bagg, Warwick
Doughty, Robert N.
Somaratne, Jithendra B.
Poppe, K.K.
ter Bals, M.M.
Wadams, Gina
Pearl, Ann
Bagg, Warwick
Doughty, Robert N.
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Date
2011
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Journal Article
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
left ventricular hypertrophy
NT-proBNP 12-lead
lead electrocardiography
type 2 diabetes
cardiovascular disease
NT-proBNP 12-lead
lead electrocardiography
type 2 diabetes
cardiovascular disease
ANZSRC Field of Research Code (2020)
Citation
Somaratne, J. B., Whalley, G. A., Poppe, K. K., ter Bals, M. M., Wadams, G., Pearl, A., ... & Doughty, R. N. (2011). Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community. Cardiovascular diabetology, 10(1), 29.
Abstract
Background: Left 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.
Methods: Prospective 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.
Results: 294 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.
Conclusions: LVH 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.
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© 2011 Somaratne et al
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© 2011 Somaratne et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited