Introduction: Diabetic cardiomyopathy is defined as myocardial dysfunction which is independent from any other ischemic, valvular or hypertensive etiology. It is a multifactorial condition caused mainly by a change in the myocardial structure leading sometimes to fibrosis especially in patients with poor diabetes control.
Aim: To assess whether type 1 diabetic children and adolescents have early echocardiographic signs of subclinical ventricular dysfunction and whether diabetes control has any influence, using conventional and nonconventional echocardiographic tools
Methods: prospective, analytical case-control design in which the patient group (G1) (duration of diabetes ≥ 1 year) was matched for age and sex with a control group (G2). Each subject had conventional transthoracic echocardiography and tissue Doppler imaging with two- dimensional speckle tracking echocardiography. Early (E, E' wave) and late (A, A' wave) diastolic myocardial velocity (m/s) and the respective ratios ; and systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) were calculated and compared within both groups.
Results: G1 and G2 comprised 40 and 31 children aged 6.2 15.5 years. The control group (G2) included 31 healthy children similar in terms of age and sex. There were no significant differences between the groups concerning body- mass index, blood pressure or heart rate. Left and right ventricular systolic function and right ventricular diastolic function were comparable between G1 and G2. By contrast, LV diastolic function for G1 and G2 showed mean (SD) E (m/s): 0.76 (0.17) vs 0.72( 0.15) (P=0.24), A (m/s): 0.63 (0.17) vs 0.59 (0.14) (P=0.031), E/A: 1.74 (0.51) vs 1.88 (0.53) (P=0.023), E' (m/s): 0.15 (0.02) vs 0.16 (0.02) (P=0.16), A' (m/s): 0.68 (0.01) vs 0.63 (0.01) (P=0.048), E'/A': 2.08 (–0.51) vs 2.31 (0.42) (P=0.045). Longitudinal basal LV strain was –18.23 (–2.82) for G1 vs –20.94 (–3.93) for G2 (P=0,032).
LV functional impairment was correlated with the duration of the diabetes; and HbA1C.
Conclusion: This study has shown early, asymptomatic diastolic left ventricular dysfunction which precedes systolic dysfunction. The data indicate that duration and control of diabetes are risk factors.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology