Early changes in cardiovascular structure and function in adolescents with type 1 diabetes

Abstract

BackgroundChildren with type 1 diabetes (T1D) are at higher risk of early adult-onset cardiovascular disease. We assessed cardiovascular structure and function in adolescents with T1D compared with healthy controls and the relationships between peripheral vascular function and myocardial parameters.Methods and results199 T1D [14.4 ± 1.6 years, diabetes duration 6.2 (2.0–12.8) years] and 178 controls (14.4 ± 2.1 years) completed endothelial function by flow mediated vasodilatation (FMD), arterial stiffness using pulse wave velocity (PWV) along with M-mode, pulse wave and tissue Doppler, and myocardial deformation echocardiographic imaging. Systolic (113 ± 10 vs. 110 ± 9 mmHg; p = 0.0005) and diastolic (62 ± 7 vs. 58 ± 7 mmHg; p < 0.0001) blood pressures, carotid femoral PWV and endothelial dysfunction measurements were increased in T1D compared with controls. Systolic and diastolic left ventricular dimensions and function by M-mode and pulse wave Doppler assessment were not significantly different. Mitral valve lateral e’ (17.6 ± 2.6 vs. 18.6 ± 2.6 cm/s; p < 0.001) and a’ (5.4 ± 1.1 vs. 5.9 ± 1.1 cm/s; p < 0.001) myocardial velocities were decreased and E/e’ (7.3 ± 1.2 vs. 6.7 ± 1.3; p = 0.0003) increased in T1D. Left ventricular mid circumferential strain (−20.4 ± 2.3 vs. −19.5 ± 1.7 %; p < 0.001) was higher, whereas global longitudinal strain was lower (−19.0 ± 1.9 vs. −19.8 ± 1.5 % p < 0.001) in T1D.ConclusionsAdolescents with T1D exhibit early changes in blood pressure, peripheral vascular function and left ventricular myocardial deformation indices with a shift from longitudinal to circumferential shortening. Longitudinal follow-up of these changes in ongoing prospective trials may allow detection of those most at risk for cardiovascular abnormalities including hypertension that could preferentially benefit from early therapeutic interventions.

Subclinical Arterial Damage in Children and Adolescents with Type 1 Diabetes: A Systematic Review and Meta‐Analysis

“…The studies were conducted in the United States, Turkey, Canada, Germany, Egypt, Austria, Poland, Estonia, Finland, Greece, Australia, Norway, Mexico, Sweden, Serbia, and the Netherlands between 2002 and 2017. Twenty studies included cIMT as outcome, and four included carotid‐femoral PWV as outcome . The characteristics of all 23 studies used for the systematic review are summarized in Table .…”

Progeria of the Heart in Type 1 Diabetic Children?

“…Although this study could not show significantly different diastolic parameters at rest, diabetic children might have impaired diastolic functional reserve during exercise 7). Recently, two-dimensional speckle tracking echocardiographic studies to demonstrate LV mechanical dysfunction more sensitively and a few studies have published in children with type 1 DM 8)9). Hensel et al10) reported that asymptomatic type 1 DM children had signs of hyperdynamic LV contractility early in the course of the disease.…”

Subclinical Myocardial Injury of Young Patients With Type1 Diabetes Mellitus Without Cardiovascular Disease

“…Полинейропатия, n (%) / Neuropathy, n (%) 27 (38) Ангиопатия, n (%)/ Angiopathia, n (%) 17 (23,9) Ретинопатия, n (%) / Retinopathy, n (%) 1 (1,4)…”

“…Патологические изменения со стороны сердечной мышцы, возникающие при СД, расцениваются как диабетическая кардиомиопатия (КМП) [2,19,23,24].…”