Left atrial dysfunction and stiffness in pediatric and adult patients with Type 1 diabetes mellitus assessed with speckle tracking echocardiography

Abstract

Background Subclinical diastolic dysfunction in patients with Type 1 diabetes mellitus (T1DM) caused by myocardial injury due to diabetic cardiomyopathy leads to a high risk of death and heart failure. This myocardial injury extends not only to the left ventricle (LV) but also to the left atrium (LA). However, LA function in children and young adults with T1DM has not been extensively studied. Objective Therefore, the aim of this study was to assess LA dysfunction in pediatric and adult patients with T1DM using LA strain analysis with echocardiography. Subjects Fifty‐three patients (median age: 23 [range: 5–41] years) with T1DM. Methods We divided the patients into three age groups (D1: 5–14 years, D2: 15–24 years, D3: 25–41 years); 53 age‐ and sex‐matched controls were divided into three corresponding groups (C1, C2, and C3). LA and LV functions were evaluated using echocardiography. Results LA reservoir strain was lower in the D2 and D3 groups than in the C2 and C3 groups (P = 0.001, P = 0.004, respectively). LA conduit strain was lower in the D2 group than in the C2 group (P = 0.002). LA stiffness was significantly greater in the D3 group than in the C3 group (P < 0.001). Conclusions In patients with T1DM, LA phasic function decreased in adolescents and young adults, and LA stiffness increased in adult patients aged >30 years. LA phasic function and LA stiffness can be potentially used as early markers for diastolic dysfunction.

Combined Algorithm-Based Adaptations of Insulin Dose and Carbohydrate Intake During Exercise in Children With Type 1 Diabetes: Results From the CAR2DIAB Study

“…Although all patients had more than 5 years of diabetes duration, no perturbation of cardiac and respiratory function tests could be observed, within limits of the assessment performed (i.e., Resting and peak HRs, baseline and peak systolic and diastolic blood pressures, VO2 max, METs, and RER). Several studies showed that children with T1D presented cardiac anomalies (i.e., Abnormal LV myocardial deformation, LV systolic and diastolic discoordination, and increased peak LV strain rate), in comparison with healthy children, and that these anomalies were associated with diabetes duration (21)(22)(23). In our study, values of resting systolic blood pressure and diastolic IVS thickness were lower in the diabetes cohort than in controls.…”

Heart Failure in Type 1 Diabetes: A Complication of Concern? A Narrative Review

“…Although the effect tends to decrease over the years, it remains highly significant 30 years later (a reduction of 30% compared to conventional treatment; p = 0.016) [ 12 , 13 ]. However, the presence of diastolic dysfunction has been demonstrated even in adolescent and young adult patients with T1D, as potential early markers of heart failure [ 14 , 15 ]. Moreover, some studies suggest that multiple risk factor control reduces the risk for myocardial infarction or stroke but has little association with the risk for HF in T1D [ 16 ].…”

“…Although left ventricular diastolic dysfunction is the earliest manifestation of HF in the diabetic population [ 53 ], recently, the role of left atrial dysfunction as an active contributor to the initial diastolic dysfunction suffered by these patients has been revealed [ 54 ]. Ifuku M et al [ 14 ] observed left atrial dysfunction (such as left Atrial phasic strain) in adolescents and young people with T1D ( n = 53) compared to non-diabetic controls ( n = 53) and assert that it could constitute an early and sensitive marker of diastolic dysfunction in T1D. The E/e′ ratio is frequently used as a marker of diastolic dysfunction (Yoldaş T, 2018).…”

The right atrium in young patients with type 1 diabetes mellitus: Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

“…Diastolic functions of both ventricles and LA mechanical functions were found to be impaired in T1DM patients with prolonged intra- and interatrial electromechanical delays [4] . In patients with T1DM, LA phasic function was found to be decreased in adolescents and young adults, while LA stiffness was increased in adult patients aged > 30 years [5] . Using the most recent 3DSTE, all LA volumes were increased and were respecting the cardiac cycle, total atrial stroke volume was increased and peak mean segmental LA-CS was reduced together with alterations in certain segmental strains in young T1DM patients [6] .…”

“…Early onset of cardiomyopathy represented by myocardial volumetric and deformation properties is a major concern for patients with type 1 diabetes mellitus (T1DM). Abnormalities in myocardial mechanics could be demonstrated featuring heart chambers in young patients with T1DM [1] , [2] , [3] , [4] , [5] , [6] , [7] . The right atrium (RA), however, was poorly examined due to its limited availability for routine echocardiographic techniques [8] , [9] .…”