How much echo left ventricular hypertrophy would be missed in diabetics by applying the Losartan Intervention For Endpoint Reduction electrocardiogram criteria to select patients for angiotensin receptor blockade?

OBJECTIVE: The Losartan Intervention For Endpoint Reduction (LIFE) study demonstrated a clear mortality benefit in treating hypertensive patients with electrocardiogram (ECG) evidence of left ventricular hypertrophy (LVH) with losartan rather than atenolol. Previous studies have also shown that identifying and treating echo LVH is associated with prognostic benefits in hypertensive subjects, and is independent of the presence of ECG LVH. We sought to determine how many cases of echo LVH would be missed by applying the ECG criteria for LVH used in the LIFE study.
DESIGN: A prospective study of 219 patients with type 2 diabetes recruited from the hospital diabetic clinic.
METHODS: Fifteen ECG criteria were assessed on each subject and compared with the presence or absence of LVH on echocardiography.
RESULTS: All the proposed ECG criteria are poor at identifying echo LVH in people with diabetes.
CONCLUSION: Using ECG LVH to select patients for angiotensin receptor blockade would lead to many diabetics with echo LVH missing out on the benefits of treatment. This assumes that the benefits seen in the LIFE study would also occur if the LIFE strategy were extended to echo LVH patients as well as to ECG LVH patients.