Ventricular diastolic dysfunction : a sign of early cardiomyopathy in young type 1 diabetics

Abstract EN

Background : The cardiomyopathy associated with diabetes is a unique myopathic state that appears to be independent of macrovascular / microvascular disease, and contributes significantly to cardiovascular disease morbidity and mortality in diabetics.

Abnormalities in ventricular diastolic function have been recently described to precede abnormalities of systolic function in adults.

Early detection of myocardial dysfunction in diabetic patients is extremely important for implementing secondary and tertiary prevention in order to improve prognosis.

As more sophisticated non-invasive techniques are available to monitor myocardial function, the opportunity now exists to more fully elucidate the natural history of "diabetic" cardiomyopathy for early detection and prevention.

Objective : The purpose of the present study was to determine whether abnormalities of ventricular diastolic filling were present in type 1 diabetics at DEMPU that might necessitate including echocardio graphic evaluation in their regular follow up protocol.

Subjects and Methods : 30 children and adolescents (18M and 12F) with typel diabetes attending the Diabetic, Endocrine Metabolic Pediatric Unit (DEMPU) at the New Children's Hospital of Cairo University.

Tlieir age range was (4.68 to 21.17 yrs), and had diabetes duration range (0.

51 to 14.

28 yrs) and different degrees of glycemic control.

Each patient was subjected to history, clinical assessment (puberty, limited joint mobility, basal heart rate, systolic and diastolic blood pressure in supine and standing positions), laboratory assessment (HbAl, total cholesterol and triglycerides).

Data regarding chronic complications, neuropathy, nephropathy and retinopathy were recorded, ECG, then echocardiography to assess diastolic ventricular fdling parameters (peak A, peak E in cm / sec, E / A, ET, AT and DT in m / sec).

Fourteen healthy children and adolescents were taken as control.

Results : Comparison between the diabetic and control groups revealed significantly increased basal HR, peak A and decreased E / A ratio in diabetics.

Diastolic dysfunction was found in 21 / 30 diabetics (70 %), 13 M and 8 F, age 4.68 -21.17 (mean 12.76 ± 4.62 yrs), diabetes duration range 0.51-14.28 (mean 5.53 ± 3.83 yrs).

Thirteen (62 %) were pre-pubertal and 15 (71.4 %) had a positive family history of diabetes.

16 diabetics had small E and large A waves, decreased E / A and prolonged AT, 3 had increased E wave only and 2 had increased both E and A waves with short DT.

Diabetics with diastolic dysfunction (21 / 30), compared to those with normal diastole (9 / 30), showed a higher frequency of positive family history of diabetes, limited joint mobility (indicating poor compliance), poor glycemic control (HbAj > 12 %) and hyperlipidemia, but not reaching statistical significance.

A significant positive correlation was found between mitral peak A velocity and basal HR; and a significant negative correlation between mitral E / A and basal HR.

Conclusion : Asymptomatic ventricular diastolic dysfunction can be detected in up to 70 % of children and adolescents with typel diabetes followed at DEMPU, which warrants including Doppler echocardiography as part of their annual screening tests.

Basal heart rate correlated significantly with diastolic function (positively with peak A velocity and negatively with E / A).

No correlation was found for diabetes duration, glycemic control (HbAj) or blood pressure with the diastolic function.

Long-term evaluation is needed for reversal of myocardial dysfunction by improvement of glycemic control and lipid abnormalities.