Diagnostic Value of Poor R-Wave Progression in Electrocardiograms for Diabetic Cardiomyopathy in Type 2 Diabetic Patients

Background: Diabetic cardiomyopathy (DCMP) is a common complication of diabetes and is associated with increased mortality. It has been suggested that a poor R-wave progression in a resting electrocardiogram (ECG) could be a sign of cardiomyopathy. Hypothesis: The aim of this study was primarily to analyze the relationship between poor R-wave progression and DCMP, and the effect of poor R-wave progression on cardiac functions in long-term follow-up. Methods: Seventy type 2 normotensive diabetics (33 female, 37 male; mean age, 52.9 +/- 10.4 years) were included in the study. Poor R-wave progression in an ECG was defined as an R wave <3 mm in V1-3 derivations. The patients were randomized in 2 groups, which were those without (group I, n=34) and those with poor R-wave progression (group II, n=36). All patients underwent conventional and tissue Doppler echocardiography and were followed in an outpatient clinic setting for 4 years. Results: Demographic variables were similar between the 2 groups. In group II, left ventricular (LV) relaxation abnormality was more prevalent, the Tei index was higher, and in tissue Doppler mitral annulus Em velocities were significantly lower and Am velocities were higher than those with normal R-wave progression. At the end of the 4-year follow-up period, LV ejection fraction was decreased in group II, whereas LV mass index and Tei index were significantly increased. Conclusions: LV diastolic dysfunction is more frequently observed in diabetic patients with poor R-wave progression in ECG, which may be an early sign of LV dysfunction and DCMP in diabetics.