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

Objectives: Non-ischemic diabetic cardiomyopathy considerably accounts for mortality in diabetes mellitus. The mechanism underlying diabetes associated heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes is scarce. In this study we utilize speckle tracking echocardiography combined with physical stress testing to evaluate whether left ventricular (LV) myocardial contractility is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM).

Methods: 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age: 11.5 ± 3.1 years, 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).

Results: Strikingly, T1DM patients had overall 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 disease duration of > 4 years (p = 0.038). Only T1DM patients with serum HbA_1C > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) as well as a reduced E/A-ratio (p = 0.031).

Conclusion: In Conclusion, asymptomatic T1DM patients have hyperdynamic LV contractility early in the course of the disease. Furthermore, poor glycemic control in T1DM is associated with early subclinical LV systolic and diastolic impairment.