Original articleLongitudinal left ventricular strain impairment in type 1 diabetes children and adolescents: A 2D speckle strain imaging study
Introduction
Type 1 diabetes (T1D) is a major cardiovascular risk factor associated with excess mortality in young adults due to premature cardiovascular events [1], including heart failure [2]. T1D involves complex metabolic disturbances in cardiomyocytes leading to morphological and functional abnormalities of the myocardium [3]. The relationship between T1D and cardiac structure and function in children and adolescents is not well established. Most of the previous studies focused on diastolic function using standard two-dimensional (2D) and Doppler echocardiography, while the study of systolic function was restricted to measurement of left ventricular ejection fraction (LVEF) [4], [5]. 2D strain imaging is a recent echocardiographic method for the assessment of myocardial function.
The left ventricular myocardium is a complex three-dimensional structure consisting of myocardial fibres orientated in different directions and responsible for three principal types of deformation, or ‘strain’: global longitudinal strain (GLS); radial strain; and circumferential strain. 2D strain imaging is a robust echocardiographic technique that enables evaluation of the three components of myocardial deformation from a standard 2D view. 2D strain imaging has been shown to be the most sensitive echocardiographic tool for the detection of the subclinical impairment of myocardial function observed in many conditions predisposing to heart failure [6].
The present study used 2D strain imaging to investigate whether T1D children and adolescents show early abnormalities in myocardial function. In addition, the relationship between these myocardial features and glycaemic control and diabetes duration were investigated.
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Population
The study prospectively recruited diabetic patients aged 5 to 18 years followed-up at the paediatric department of the Caen teaching hospital. T1D was diagnosed according to World Health Organization criteria [7] together with the permanent need for insulin therapy. Exclusion criteria were the presence of cardiopathy, significant concomitant disease, medication known to modify cardiac function, high blood pressure, smoking, dyslipidaemia and obesity [defined as a body mass index (BMI), adjusted
Study population
Between January 2012 and January 2013, 100 children and adolescents with T1D (age: 11.3 ± 3.6 years, 52 boys) were consecutively recruited at our paediatric endocrinology department from a cohort of 152 diabetes patients. Reasons for non-inclusion were: age > 18 years (n = 10) or < 5 years (n = 9); diabetes duration < 1 year (n = 23); obesity (n = 7); and refusal to participate (n = 3). Diabetes duration ranged from 1.1 to 16 years (median: 5.1 ± 3.1 years). Results in the diabetes patients were compared with those in
Discussion
Our study suggests that diabetes in childhood is associated with alteration of longitudinal LV deformation. These myocardial deformation changes appear to be related to glycaemic control.
Previous echocardiographic studies in diabetic children focused on LV diastolic function and suggested a reduction in early diastolic filling based on transmitral flow analysis [4], [5], [9], [10]. On evaluating LVEF, all previous studies conducted in diabetic children concluded the absence of LV systolic
Conclusion
Our study has suggested that LV longitudinal function is impaired in young patients with T1D, and glycaemic control may be the main risk factor for the myocardial changes. Further follow-up is now necessary to precisely elucidate the clinical significance of the myocardial changes detected by 2D strain imaging in T1D children.
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgements and author's contributions
All authors contributed significantly to this work (FL researched data and wrote the manuscript; FL, AP, ES performed the echocardiograms; ML and VR researched data), contributed to the discussion and reviewed the manuscript. ES, PM, DK, PM, AM and JB critically revised the manuscript. RM did the statistical analysis. FL is the guarantor of this work and, as such, had full access to all the data in the study, and takes responsibility for the integrity of the data and accuracy of the data
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