T-wave axis deviation and Left Ventricular Hypertrophy interaction in diabetes and hypertension.

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±11years) and 8775 men (54±11years) 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) >35mm 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.