Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study

• Published in: Journal of Diabetes Research Vol. 2016; no. 2016; pp. 1 - 12
• Main Authors: Wirth, Stefan, Jenke, Andreas, Roskopf, Markus, Grimmer, Franziska, Hensel, Kai O., Heusch, Andreas
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2016; John Wiley & Sons, Inc; Hindawi Limited; Wiley
• Subjects: Adolescent; Age Factors; Asymptomatic Diseases; Bicycling; Biomarkers - blood; Biomechanical Phenomena; Blood pressure; Cardiomyopathy; Cardiovascular disease; Case-Control Studies; Child; Congenital diseases; Development and progression; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - drug therapy; Diabetic Cardiomyopathies - diagnostic imaging; Diabetic Cardiomyopathies - etiology; Diabetic Cardiomyopathies - physiopathology; Disease Progression; Echocardiography; Echocardiography, Doppler; Echocardiography, Stress - methods; Exercise Test; Female; Glycated Hemoglobin A - analysis; Health aspects; Heart failure; Heart ventricle, Left; Humans; Hypertension; Hypoglycemic Agents - therapeutic use; Ischemia; Male; Medical examination; Myocardial Contraction; Pediatrics; Predictive Value of Tests; Prospective Studies; Regulation; Stress, Mechanical; Time Factors; Type 1 diabetes; Ultrasonic imaging; Ventricular Function, Left; Work stations; United States > US
• ISSN: 2314-6745; 2314-6753
• DOI: 10.1155/2016/2583747

Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal ( p = 0.019 ) and circumferential ( p = 0.016 ) strain rate both at rest and during exercise ( p = 0.021 ). This was more pronounced in T1DM patients with a longer disease duration ( p = 0.038 ). T1DM patients with serum H b A 1 c > 9 % showed impaired longitudinal ( p = 0.008 ) and circumferential strain ( p = 0.005 ) and a reduced E/A-ratio ( p = 0.018 ). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment.