Electrocardiographic Features in Patients with Diabetes Mellitus Who Are Asymptomatic for Cardiac Disease and Utility of Poor R-wave Progression in Predicting Cardiac Function

Background and Aim: Diabetes mellitus can affect almost every organ system in the body. It is a point of concern for cardiovascular morbidity and mortality. Early pathological changes in the myocardium can be seen in patients with diabetes and can be picked up by a simple bedside tool – 12-lead electrocardiogram (ECG). This study was done to determine the electrocardiographic features in patients with diabetes mellitus who are asymptomatic for cardiac disease and the utility of poor R-wave progression (PRWP) in predicting cardiac function. Materials and Methods: This prospective observational study was done in a single tertiary care center in South India among patients who attended an outpatient clinic over a period of 1 year. The patients with type 1 or 2 diabetes who were asymptomatic for cardiac disease were given the 12-lead ECG. The baseline cardiovascular characteristics were analyzed. An echocardiography was performed for patients with PRWP to look for cardiac function by ejection fraction, and it was compared with the participants without PRWP. Appropriate statistical tests like P value were used to determine the significance of the study, and descriptive statistics were obtained for all variables and entered in MS Excel and analyzed with SPSS (SPSS for Windows, version 16.0, Chicago, IL, USA). Results: One hundred and twenty-five patients were analyzed. 80.8% of asymptomatic patients had ECG changes. The common ECG findings were left atrial enlargement – 5.6%, resting sinus tachycardia – 6.4%, ST-T changes – 12%, QTc prolongation or QTc dispersion – 11.2%, left ventricular hypertrophy, and PRWP – 13.6%. Among patients with PRWP, 7/17 (41.17%) had heart failure on the 2D echo, P = 0.015. Hence, PRWP was an independent predictor of heart failure in diabetics asymptomatic for cardiac disease. Conclusion: 12-lead ECG is an important tool for detection and screening of myocardial injury in asymptomatic diabetics. Furthermore, PRWP is an independent predictor of heart failure in asymptomatic diabetics.