Echocardiographic Left Ventricular Hypertrophy Among Patients with Type 2 Diabetes Undergoing Clinically Indicated Echocardiography at a Saudi Cardiac Center: Prevalence and Associated Factors

Background/Objectives: Left ventricular hypertrophy (LVH) is an important cardiovascular complication, but regional data on this condition among patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia remain limited. This study determined the prevalence of LVH and associated factors among adults with T2DM without documented cardiac disease undergoing clinically indicated echocardiography at a specialized cardiac center in Saudi Arabia. Methods: This retrospective cross-sectional study included 625 patients with T2DM who underwent clinically indicated echocardiography at Prince Sultan Cardiac Center, Qassim, between January 2023 and December 2025. Of 878 patients with T2DM and no documented cardiac disease assessed for eligibility, 253 (28.8%) were excluded because at least one required clinical variable was missing or unavailable, leaving 625 patients (71.2%) in the final analysis. LVH was assessed according to American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations. Multivariable logistic regression was used to evaluate factors associated with LVH. Results: LVH was identified in 146/625 patients (23.4%; 95% CI, 20.0–26.7). After multivariable adjustment, male sex (aOR = 1.71, 95% CI: 1.11–2.63; p = 0.015) and uncontrolled/elevated blood pressure (aOR = 2.18, 95% CI: 1.26–3.80; p = 0.006) were associated with LVH. Diabetes duration showed a significant nonlinear association with LVH (overall p < 0.001; p for nonlinearity = 0.001). Conclusions: LVH was common among this clinically selected group of patients with T2DM undergoing clinically indicated echocardiography. Male sex and uncontrolled/elevated blood pressure were associated with LVH after adjustment, while diabetes duration showed a nonlinear association. Although causal relationships cannot be established, the observed association between uncontrolled/elevated blood pressure and LVH highlights the importance of optimal blood pressure management as part of comprehensive cardiovascular risk reduction in patients with T2DM.