Does Type 1 Diabetes Effect Left Ventricular Function in Children? Evaluation with Treadmill Exercise Stress Echocardiography

Özge Köprülü; Gamze Vuran; Timur Mese; Behzat Ozkan

Introduction: Subclinical left ventricular (LV) dysfunction may occur in chronic diseases such as type 1 diabetes mellitus (T1DM). For the patients at the early asymptomatic stage, LV reserve function is a sensitive index to detect subtle LV dysfunction. The purpose of our study is to assess the LV reserve function using treadmill exercise stress echocardiography (ESE) in children with T1DM.

Method: The study was planned as a cross-sectional study and included 12 children T1DM and 12 sex- and age-matched healthy controls. All those children completed treadmill ESE, LV systolic function-related parameters such as global longitudinal strain (LGS) and circumferential strain (CGS), as well as diastolic function-related parameters such as E wave (E), A wave (A), early diastolic velocity (e’), late diastolic velocity (a’), E/e′ ratio were compared at rest and immediately after exercise.

Results: Weight, weight SDS, height, height SDS, Body mass index (BMI) and BMI SDS were similar between the groups. Baseline (pre-exercise) conventional echocardiographic parameters, tissue Doppler imaging (TDI) and two-dimensional speckle tracking echocardiography measurements did not reveal any statistically significant difference between the two groups in terms of systolic and diastolic function. LV systolic reserve function, as measured by rest and post-exercise LGS were significantly impaired in patients with T1DM (P <0.001). However, patients with T1DM did not significantly vary from the controls in LV diastolic reserve measures.


	Rest			Post-exercise
	T1DM	Control	p	T1DM	Control	p
Systolic function
LGS (%)	18.24 ± 1.6	21.08 ± 1.28	P < 0.001	19.34 ± 1.29	22.16 ± 1.66	P < 0.001
CGS (%)	24.16 ± 2.26	24.58 ± 2.58	0.69	24.76 ± 2.28	25.87 ± 0.27	0.27
Diastolic function
E (cm/s)	88.36 ± 14.33	84.78 ± 15.77	0.583	90 ± 16.74	88.11 ± 8.95	0.752
A (cm/s)	55.6 ± 10.22	51.9 ± 12.02	0.444	61.88 ± 11.58	63.62 ± 14.71	0.76
E/A	1.61 ± 0.25	1.67 ± 0.38	0.648	1.46 ± 0.18	1.42 ± 0.24	0.224
E-e’	5.83 ± 1.5	5.21 ± 1.04	0.287	5.38 ± 1.36	4.64 ± 0.77	0.144
e’ (cm/s)	15.75 ± 3.99	16.34 ± 2.52	0.695	17.27 ± 3.59	19.24 ± 3.72	0.066
a’ (cm/s)	96.43 ± 1.09	7.51 ± 1.68	0.086	7.09 ± 1.33	8.31 ± 1.61	0.402
s’ (cm/s)	10.5 ± 1.98	10.84 ± 2.64	0.735	11.29 ± 2.69	12.28 ± 2.67	0.685
Data were presented as mean±SD. E: peak early LV inflow velocity; A: peak late LV inflow velocity; e’: peak early diastolic tissue velocity; a’: peak late diastolic tissue velocity; s’: peak systolic tissue velocity

Conclusion: To our knowledge, this is the first study examine the LV reserve function with treadmill exercise stress echocardiography in children with T1DM. We found that children with T1DM exhibited impaired systolic reserve function, while diastolic reserve function remained preserved.

ESPE Abstracts

FC1.1