OBJECTIVE -This study was designed to assess whether children and adolescents with type 1 diabetes have early echocardiographic signs of subclinical cardiac dysfunction and whether sex, state of metabolic control, and diabetes duration are of influence.RESEARCH DESIGN AND METHODS -Systolic and diastolic blood pressure in supine and upright positions and echocardiographic parameters, including tissue Doppler measurements of the septal mitral annulus, were evaluated in 80 children and adolescents with stable type 1 diabetes and 52 age-and sex-matched control subjects. A possible correlation was examined for age, sex, HbA 1c , and diabetes duration with univariate and multivariate regression analysis. 58 Ϯ 8 ms) compared with female control subjects, suggesting delayed myocardial relaxation. Male diabetic patients only differed significantly from their control subjects for IVRT (66 Ϯ 9 vs. 59 Ϯ 8 ms). The measured parameters showed an expected correlation with age and BMI standard deviation scores in the control group. This correlation was significantly weaker in the diabetic population; only a weak influence was found for diabetes duration and glycosylated hemoglobin levels. RESULTSCONCLUSIONS -Young diabetic patients already have significant changes in left ventricular dimensions and myocardial relaxation, with the girls clearly being more affected. Tissue Doppler proved to have additional value in the evaluation of ventricular filling in this population. Almost no correlation was found for diabetes duration and HbA 1c with the cardiovascular changes. Diabetes Care 27:1947-1953, 2004S everal studies have established diabetes as a strong risk factor for cardiovascular morbidity and mortality, especially in women (1-4). This increased risk cannot be explained only by the high prevalence of comorbidity, such as coronary heart disease or arterial hypertension in diabetes (5). Therefore, the existence of a "diabetic" cardiomyopathy distinct from ischemic heart disease has been suggested to cause systolic or diastolic dysfunction (1,6,7). Considerable debate exists regarding the exact nature and cause of this cardiac dysfunction (8 -11). The autonomic nervous system dysfunction explains the frequently reported higher heart rate in diabetic patients compared with normal subjects and may result in changed cardiac dynamics (12,13). We previously reported that corrected QT prolongation and an increased QT dispersion are already present in children with diabetes (14), and these abnormalities have been linked to an increased mortality rate in adults (15). Adult diabetic patients without clinical heart failure are reported to have hypertrophic and noncompliant left ventricles, causing essentially diastolic dysfunction (16 -20). The association between these findings and metabolic control or diabetes duration is controversial (21,22). The aim of this study was to determine whether echocardiographic signs of diastolic or systolic dysfunction are already present in diabetic children and adolescents, a population in whom comorbid...

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Objective: To describe the prepubertal growth pattern in boys with delayed puberty. Methods: Growth curves for height and height velocity covering the age range 4–14 years were constructed on the basis of retrospectively obtained data in 85 boys with delayed puberty, who attained a normal final height. Results: Between the age of 4 and 14 years the height in this cohort progressively deviated from the normal reference. At the age of 4 years, the height SDS was already significantly lower (median –0.8; p < 0.001) and progressively diminished during childhood, resulting in a median height SDS of –1.1 at the age of 12 years (p < 0.001). The median final height of this cohort (–0.4) was not different from their target height (–0.2). The degree of deceleration in growth during childhood was not determined by birth weight or birth height and did not influence final height. The decline of the height velocity with age in this group of boys with delayed puberty was significantly smaller (p < 0.001) than predicted by the model of Rikken and Wit. Conclusion: Late-maturing boys often show a prepubertal deceleration in growth that starts at an early age but that does not affect final height.