title: T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension.
abstract: Electrocardiographic signs of left ventricular hypertrophy (ECG-LVH) and T-wave axis (TA) deviation are independent predictors of fatal and non fatal events. We assessed the prevalence of ECG-LVH, TA abnormalities and their combination according to the presence or absence of diabetes and/or hypertension in a large sample of the adult general Italian population. Data from 10,184 women (54 ± 11 years) and 8775 men (54 ± 11 years) were analyzed from the Moli-sani cohort, a database of randomly recruited adults (age >35) from the general population of Molise, a central region of Italy that includes collection of standard 12-lead resting ECG. Subjects with previous myocardial infarction, angina, cerebrovascular disease or left bundle brunch block or missing values for TA or ECG-LVH have been excluded. TA was measured from the standard 12-lead ECG and it was defined as the rotation of the T wave in the frontal plane as computed by a proprietary algorithm (CalECG/Bravo, AMPS-LLC, NY). ECG-LVH was defined as Sokolow Lyon voltage (SLv) >35 mm or Cornell voltage duration Product (CP) >= 2440 mm*ms. Among subjects with ECG-LVH, prevalence of hypertension was 59.0% and 49.7%, respectively for men and women, whereas that of diabetes was 10.7% and 5.7%. In hypertensives, TA was normal in 72.3% of subjects, borderline in 24.8% and abnormal in 2.9%. In diabetics, TA was normal in 70.4% of subjects, borderline in 26.5% and abnormal in 3.1%. In both hypertensive and diabetic subjects, the prevalence of ECG-LVH, was significantly greater in subjects with borderline or abnormal TA. Hypertension was an independent predictor of abnormal TA (odd ratio: 1.38, P = .025). These results suggest that hypertension might play a relevant role in the pathogenesis of TA deviation.
authors.affiliation: Department of Sports-Internal Medicine, University of Brescia, Brescia, Italy.
authors.forename: Deodato
authors.initials: D
authors.lastname: Assanelli
authors.forename: Augusto
authors.initials: A
authors.lastname: Di Castelnuovo
authors.forename: Livia
authors.initials: L
authors.lastname: Rago
authors.forename: Fabio
authors.initials: F
authors.lastname: Badilini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vinetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Gianfagna
authors.forename: Massimo
authors.initials: M
authors.lastname: Salvetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Zito
authors.forename: Maria Benedetta
authors.initials: MB
authors.lastname: Donati
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Gaetano
authors.forename: Licia
authors.initials: L
authors.lastname: Iacoviello
mesh_terms: D015984:Causality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution
keywords: Coronary artery disease; Diabetes; Hypertension; Left ventricular hypertrophy T-wave axes