Two-Dimensional Speckle Tracking Versus Applanation Tonometry in Evaluation of Subclinical Atherosclerosis in Children with Type 1 Diabetes Mellitus

Abstract

Background: Patients with type 1 diabetes mellitus (T1DM) often develop atherosclerosis at an early age. In the subclinical stage of the process, minimal/non-morphological changes can be noticed, but the arterial wall function can be impaired. Applanation tonometry allows to assess the arterial tree stiffness; however, the Two-Dimensional Speckle Tracking (2DST) is an increasingly accepted alternative. This study evaluated arterial wall stiffness using these 2 techniques in children with T1DM. Material/Methods: We performed applanation tonometry and carotid arteries sonography with evaluation of the carotid intimamedia thickness (cIMT) and use of the 2DST in 50 children with T1DM and in 50 healthy sex-and age-matched controls. We also assessed the reliability of 2DST in 10 random subjects. Results: Children with T1DM had increased arterial wall stiffness, which was confirmed by tonometry (PWV: p=0.0386) and 2DST (Strain: p=0.0004; Strain rate: p=0.0081). There was no significant difference in cIMT between groups (0.45±0.06 vs. 0.43±0.05, p=0.073 in children with T1DM and controls, respectively). 2DST presented good intraclass correlation coefficient between researchers and within a single researcher. Conclusions: Children with T1DM presenting with subclinical stage of atherosclerosis were found to have arterial wall stiffening. The 2DST, the same as applanation tonometry, allows to recognize this condition but in a more accessible and reproducible manner.

“Apple does not fall far from the tree” – subclinical atherosclerosis in children with familial hypercholesterolemia

“…Currently, purchasing of 2DST software is cheaper than buying an applanation tonometer, which handling requires experience. Moreover, repeatability of the stain evaluation with 2DST is higher than reported for tonometry, while their results correlate with each other [ 11 , 30 ]. Finally, sonography is the most comprehensive technique because after storing a few loops of arterial wall motion not only function surrogates can be calculated in a semiautomatic manner, but also IMCT and atherosclerotic plaques can be assessed, what would be especially important in older patients.…”

“…Then the sonographic and tonometric tests were performed by two independent researches blinded to the group affiliation. Examinations techniques were standard, and the detailed description together with accuracy and reproducibility for adults and children was reported before [ 9 – 11 ].…”

“…On the other hand, a novel sonographic technique - the 2-dimensional speckle tracking (2DST) - can be an alternative that proved its usefulness in evaluation of risk groups of adults [ 9 , 10 ] and children as well [ 11 ]. This method allows to assess pattern of arterial wall deformation due to the flowing pulse wave.…”

“Apple does not fall far from the tree” – subclinical atherosclerosis in children with familial hypercholesterolemia.

“…Then the sonographic and tonometric tests were performed by two independent researches blinded to the group a liation. Examinations techniques were standard, and the detailed description together with accuracy and reproducibility for adults and children was reported before [9][10][11].…”

“…On the other hand, a novel sonographic technique -the 2-dimensional speckle tracking (2DST) -can be an alternative that proved its usefulness in evaluation of risk groups of adults [9,10] and children as well [11]. This method allows to assess pattern of arterial wall deformation due to the owing pulse wave.…”