Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Abstract

Background and Objectives: Type 1 diabetes is a major cardiovascular risk factor associated with an excess of mortality in young adults due to premature cardiovascular events, which includes heart failure. The relation between type 1 diabetes and cardiac structure and function in children was poorly documented. Our study investigates (1) whether type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction assessed by tissue Doppler strain and (2) whether state of metabolic control and diabetes duration have any influence on the cardiac event. Methods: Standard echocardiography and tissue Doppler imaging were prospectively performed in type 1 diabetic children. Left ventricular dimensions, standard indices of systolic and diastolic function, and septal longitudinal strain were investigated. Results: Thirty consecutive asymptomatic diabetic children (age: 12.4 [5-17] years; males: 53%) were compared to 30 age and sex-matched healthy control subjects. Left ventricular mass index and diastolic septal thickness were significantly increased in diabetic children. There was no difference between two groups as regards the left ventricular ejection fraction and conventional mitral Doppler parameters (E, A, Ea). The global longitudinal systolic strain and strain rate were found to be decreased in children with diabetes. The global longitudinal early diastolic strain rate (Esr) was negatively correlated with metabolic control. Longitudinal strain was not correlated with diabetes duration. Conclusion: Children with Type 1 diabetes had subclinical alterations in left ventricular size and longitudinal myocardial deformation.

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

“…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 . This finding is in contrast to other studies proved that the impairment in longitudinal strain is one of the earliest signs of myocardial dysfunction in type 1 DM in due to the subendocardial damage caused by coronary microvascular ischemia …”

In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Type 1 Diabetes Mellitus Using Layer-Specific Strain Analysis

“…27 In previous studies, LVEF was not found to be significantly different in T1DM patients compared with normal controls. [15][16][17][18]28 These findings suggest that LVEF decreases in the late period after the onset of T1DM. On color Doppler echocardiography, the A-wave velocity and e' in the D3 group decreased compared with the C3 group, which was similar to the results from previous reports.…”

“…Other previous studies also showed that a reduction in strain values occurred before changes in conventional parameters, such as LVEF and diastolic parameters derived by pulse wave Doppler and tissue Doppler imaging. 17,18 However, those studies evaluated strain using monolayer analysis. The recently introduced monitored more carefully for cardiac function, even when HF is not occurring.…”

Cardiac Dysfunction in Adolescents With Type 1 Diabetes: Contribution of Daily-life Glucoregulation and Impact on Cardiorespiratory Exercise Capacity

“…This means that the peak early diastolic velocity was higher, without a significant change in filling pattern (E/A) between both groups. Prior research could not reveal such difference in E (Bradley et al, 2016;Brunvand et al, 2017;Hodzic et al, 2016) in T1DM patients as opposed to controls. One study however reported differences in E in poorly controlled T1DM subjects compared to subjects with good glycemic control and non-diabetic controls, with significantly lower values related to poor control as opposed to good control and controls without T1DM (Caglar Acar, Epcacan, Uner, Ece, & Dogan, 2016).…”

“…Furthermore, the LV longitudinal and radial function showed impairments in asymptomatic children with T1DM with a normal LV ejection fraction (EF) (Altun et al, 2016). Alterations in LV size and longitudinal myocardial deformation can be present with a shift to circumferential shortening (Bradley et al, 2016;Hodzic et al, 2016).…”