Asymptomatic Cardiomyopathy in Children and Adolescents with Type 1 Diabetes Mellitus: Association of Echocardiography Indicators with Duration of Diabetes Mellitus and Metabolic Parameters

Abstract

This study was designed to determine the relationship of dimensions, wall thickness and function of the left ventricle with diabetes duration, fasting blood glucose, lipid profile, beta-OH-butyrate, free fatty acids (FFA) and carnitine levels in children and adolescents with type 1 diabetes mellitus (DM1) who had no cardiovascular complications. Thirty-five patients with DM1 (18 F/17 M, mean age: 12.0 years) and age matched control children (n = 24) were enrolled in the study. Patients with DM1 were subdivided into Group I (mean DM1 duration 3.5 years, n = 14), and Group II (mean DM1 duration 8.2 years, n = 21). Dimensions, wall thickness and systolic functions of the left ventricle were normal in all patients with DM1. Diastolic functions were normal in Group I. In Group II, peak A wave velocity (AVEL) (p = 0.004), velocity-time integral of A wave (AVTI) (p = 0.007) and isovolumetric relaxation time corrected by heart rate (cIVRT) (p = 0.048) were high, and peak E wave velocity (EVEL) and velocity-time integral of E wave (EVTI) were normal. E/A (p < 0.0001) and EVTI/AVTI (p = 0.001) were low in this group. In Group I, systolic and diastolic blood pressure, HDL-cholesterol and FFA values were normal; total cholesterol (p = 0.047), LDL-cholesterol (p = 0.017), beta-OH-butyrate (p = 0.003), and acetyl carnitine (p = 0.006) levels were high. In Group II, diastolic blood pressure (p = 0.008), total cholesterol (p < 0.0001) and LDL-cholesterol (p < 0.0001) were increased; and total carnitine (p = 0.019), free carnitine (p = 0.002) and HDL-cholesterol (p = 0.039) were decreased. Correlations were detected between total carnitine and AVEL and HR; free carnitine and AVEL, E/A and HR; HbA1c and EVTI/AVTI and cIVRT; LDL-cholesterol and E/A, EVTI/AVTI ratios and cIVRT; HDL-cholesterol and AVEL; FFA and LVDD, IVSD, LVPWD, LVmass and CO; metabolic parameters and DM1 duration and echocardiographic findings such as AVEL, EVEL, EVTI, VmaxAV and CO. In conclusion, left ventricular dimensions, wall thickness and systolic functions were normal in children and adolescents with DM1 who had no obvious cardiovascular complications. Left ventricular diastolic functions were abnormal in patients of Group II. Left ventricular diastolic function abnormalities were associated with glycemic control, free and total carnitine, and LDL- and HDL-cholesterol levels.

Left Ventricular Diastolic Dysfunction in Adolescents with Type 1 Diabetes Reflects the Long- but Not Short- Term Metabolic Control

“…The present results are in agreement with data reported by some other authors 13,14,17 and point to the presence of early, still asymptomatic signs of impaired cardiac muscle relaxation and compliance in diabetic patients, the consequence of which might be found in cardiac muscle functional and morphological abnormalities observed in adult patients with type 1 diabetes. This is the more likely in that these patients demonstrate signs of cardiac muscle dysfunction without the presence of any additional, traditional risk factors, such as hypertension, disturbances of lipid metabolism or coronary atheromatosis 18 .…”

“…The results of the present study seem to confirm this thesis, while they indicate a significant effect of prolonged hyperglycemia defined by the mean HbA1c values calculated for the entire treatment duration and for the two years prior to the study on development of negative changes in the cardiac diastolic function. While analyzing echocardiographic parameters, we have not demonstrated their dependence on the degree of metabolic control in the last three months prior to the study, which was in agreement with observations reported by other authors 2,13,14 . On the other hand, the analysis of the association between cardiac morphology and function and long-and medium term metabolic control showed a significant effect of unsatisfactory metabolic control in both these periods on the increase of IRT and dimension of the posterior LV wall during the systole in the girls, as well as the A wave value in both genders.…”

“…According to former published papers, the LV systolic function in children, adolescents, and adults with type 1 diabetes is poorer 5,8 , the same 7,13,14 or even better 9,10 as compared to healthy peers. Regarding the diastolic function, some authors report no significant differences in parameters assessing the diastolic function in patients with type 1 diabetes as compared to control subjects 9,11 , while others point to varying degrees of impairment [12][13][14] in adolescents and adults with type 1 diabetes or solely in those patients that demonstrate signs of microangiopathy 2 . Discrepancies in the results published to date are most likely the effect of a small number of subjects in the investigated groups (20-40 individuals) and disregard of differences associated with gender, age (age of study subjects: 4-40 years) and the presence of micro and macroangiopathy-type complications of diabetes mellitus 2,5-14 .…”

Lipid Profile and Correlation to Cardiac Risk Factors and Cardiovascular Function in Type 1 Adolescent Diabetics from a Developing Country

“…Though our patients with longer disease duration had poorer glycemic control and higher serum cholesterol, they did not manifest any significant changes in the carotid artery parameters, similar to data reported by Gunczler et al [28]. Conversely few other authors have identified early cardiac changes in the presence of longer diabetes duration [29, 30]. …”

Effect of glycemic control on the progress of left ventricular hypertrophy and diastolic dysfunction in children with type I diabetes mellitus

“…In the present study, though there was a trend for patients with LVH to have the level of HbAlc to be higher (9.5±0.8%) than those without LVH (8.5±1.5%), but this trend was not significant statistically. Other authors also reported that there is no correlation between HbA1c and the development of cardiovascular changes in children and adolescents with type I DM, which is similar to results of the current study (21,26). In the same previous study, Giunti et al (21), reported that left ventricular systolic function was comparable in both diabetics and controls which was the same result obtained in our study.…”