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 age11.5±3.1years and mean disease duration4.3±3.5years) 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 serumHbA1c>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.
Detection of Subclinical Left Ventricular Dysfunction by Two-Dimensional Speckle Tracking and Tissue Doppler Echocardiography in Young Patients with Type 1 Diabetes Mellitus
