The influence of real-time blood glucose levels on left ventricular myocardial strain and strain rate in pediatric patients with type 1 diabetes mellitus - a speckle tracking echocardiography study

Abstract

BackgroundEchocardiographic myocardial performance parameters such as strain and strain rate are increasingly used to assess systolic and diastolic function in patients with diabetes mellitus and several other clinical and scientific scenarios. While long-term metabolic marks such as HbA1C are inherently assessed in diabetic patients, the actual blood glucose level at the very moment of the echocardiographic study has not yet been taken into account for the assessment of cardiac mechanics. The aim of this study was to investigate the influence of real-time blood glucose levels on left ventricular (LV) myocardial strain and strain rate in pediatric patients with type 1 diabetes mellitus (T1DM).MethodsWe performed speckle tracking echocardiography on 39 normotensive pediatric patients with uncomplicated type 1 diabetes mellitus (mean age 11.5 ± 3.5 years, 40 % female) and 44 sex- and age-matched healthy controls (mean age 11.4 ± 2.9 years, 45 % female). T1DM patients were sub-categorized according to their blood sugar levels (with a cutoff of 150 mg/dL) at the moment of the echocardiographic exam. Investigators were blinded to the participants’ study group status.ResultsInterestingly, diabetic patients with higher blood sugar levels demonstrated significantly increased LV circumferential strain (p = 0.003) and strain rate (p = 0.005) as well as global longitudinal strain rate (p = 0.002) in comparison to T1DM patients with lower blood sugar levels or healthy controls.ConclusionsFor the investigation of myocardial performance with sensitive methods such as speckle tracking echocardiography in diabetic study populations real-time blood sugar levels should be taken into account. Further studies are needed to verify these findings in large-scale patient cohorts and serial intra-individual measurements in different metabolic states.

Youth with type 1 diabetes have worse strain and less pronounced sex differences in early echocardiographic markers of diabetic cardiomyopathy compared to their normoglycemic peers: A RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) Study

“…The mechanism(s) contributing to the sex difference in LS are unlikely to be explained by conventional risk factors, as boys and girls with T1D in our cohort had similar glycemic control, diabetes duration, blood pressure and baseline physical activity. While we did not observe a significant relationship between HbA1c, LS and CS in adolescents with T1D in our study, others have reported an association between acute glycemia and myocardial strain (11, 12). It is known that the diabetic myocardium is more susceptible to injury, and perhaps there also is loss of the preferential female myocardial adaption to stress in T1D (40–42).…”

Left ventricular functions in pediatric patients with ten years or more type 1 diabetes mellitus: Conventional echocardiography, tissue Doppler, and two‐dimensional speckle tracking study

“…They suggested that longitudinal fibers are affected early in diabetic cardiomyopathy, whereas the circumferential function affected only in long durations exceeding 10 years or coexisting complications. On the contrary, a pediatric study reported a significant increase in GCS on short‐duration diabetes (mean of 3.2 years) without GLS changes . Moreover, Bjornstad et al found a significantly lower GCS with unaffected GLS in adolescent T1DM patients with a median disease duration of 4.6 years .…”

Impaired Left Atrial Conduit Function in Coronary Artery Disease Patients With Poorly Controlled Diabetes: Two-Dimensional Speckle-Tracking Echocardiographic Study

“…In a recent study, it was revealed that in pediatric patients with type 1 diabetes, blood sugar at the time of echocardiography was able to affect LV systolic deformation . According to that study, diabetic patients with real‐time blood sugar >150 mg/dL had a lower absolute value of LV systolic deformation.…”