Lutale J J K, Thordarson H, Gulam-Abbas Z, Vetvik K, Gerdts E
Institute of Medicine and Centre for International Health, University of Bergen, Bergen, Norway.
Cardiovasc J Afr. 2008 Jan-Feb;19(1):8-14.
Left ventricular hypertrophy (LVH) has been demonstrated to be a powerful predictor of cardiovascular (CV) morbidity and mortality in diabetic as well as hypertensive patients. However, less is known about the prevalence of electrocardiographic LVH (ECG-LVH) and its relation to other CV risk factors in diabetic patients in sub-Saharan Africa. Therefore, the aim was to assess the prevalence of ECG-LVH in diabetic patients in Dares Salaam, Tanzania, and its relation to other cardiovascular risk factors.
Two hundred and thirty-seven consecutive patients attending the Muhimbili diabetic clinic were studied. ECG-LVH was diagnosed by Sokolow-Lyon voltage and Cornell voltage-duration product criteria. Q waves, ST-segment deviation, T-wave abnormalities and intraventricular conduction defects were classified by the Minnesota codes. Blood pressure (BP), serum creatinine, cholesterol and triglyceride levels, and HbA 1c and urinary albumin and creatinine concentrations were determined.
The prevalence of LVH in patients was 16% by either ECG criteria; 12.2% by Sokolow-Lyon and 5.1% by Cornell product criteria. Patients with LVH had significantly higher systolic and mean BP and pulse pressure, and a higher prevalence of ST-segment abnormalities, T-wave inversion and albuminuria than those without LVH (all p < 0.05). In multivariate logistic regression analysis, systolic BP was the only independent predictor of ECG-LVH. The prevalence of ECG-LVH increased by 15% per 10 mmHg higher systolic BP [OR 1.151 (95% CI 1.009-1.314), p < 0.05]. Clustering of cardiovascular risk factors differed significantly between type 1 and type 2 diabetes patients. On average, type 1 patients had 0.8 and type 2 had 2.2 additional CV risk factors.
ECG-LVH was present in 16% of diabetic patients in Tanzania. Systolic BP was the most important predictor of ECG-LVH. Clustering of CV risks was significantly higher in type 2 than in type 1 diabetics, demonstrating the need for systematic multiple risk-factor assessment in these patients.
左心室肥厚（LVH）已被证明是糖尿病患者和高血压患者心血管（CV）发病和死亡的有力预测指标。然而，关于撒哈拉以南非洲糖尿病患者心电图左心室肥厚（ECG-LVH）的患病率及其与其他心血管危险因素的关系，人们了解较少。因此，本研究旨在评估坦桑尼亚达累斯萨拉姆糖尿病患者中ECG-LVH的患病率及其与其他心血管危险因素的关系。
对连续就诊于穆希姆比利糖尿病诊所的237例患者进行研究。根据索科洛-里昂电压和康奈尔电压-时限乘积标准诊断ECG-LVH。Q波、ST段偏移、T波异常和室内传导缺陷根据明尼苏达编码进行分类。测定血压（BP）、血清肌酐、胆固醇和甘油三酯水平，以及糖化血红蛋白（HbA1c）、尿白蛋白和肌酐浓度。
根据任何一项心电图标准，患者中LVH的患病率为16%；根据索科洛-里昂标准为12.2%，根据康奈尔乘积标准为5.1%。与无LVH的患者相比，LVH患者的收缩压、平均血压和脉压显著更高，ST段异常、T波倒置和蛋白尿的患病率也更高（所有p<0.05）。在多因素逻辑回归分析中，收缩压是ECG-LVH的唯一独立预测因素。收缩压每升高10 mmHg，ECG-LVH的患病率增加15%[比值比1.151（95%置信区间1.009-1.314），p<0.05]。1型和2型糖尿病患者心血管危险因素的聚集情况有显著差异。平均而言，1型患者有0.8个额外的心血管危险因素，2型患者有2.2个。
坦桑尼亚16%的糖尿病患者存在ECG-LVH。收缩压是ECG-LVH最重要的预测因素。2型糖尿病患者心血管风险的聚集显著高于1型糖尿病患者，表明对这些患者进行系统的多危险因素评估很有必要。
