Yoldaş Tamer, Örün Utku Arman, Sagsak Elif, Aycan Zehra, Kaya Özkan, Özgür Senem, Karademir Selmin
Department of Pediatric Cardiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
Department of Pediatric Endocrinology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
Echocardiography. 2018 Feb;35(2):227-233. doi: 10.1111/echo.13764. Epub 2017 Dec 3.
Cardiac dysfunction is a well-known consequence of diabetes mellitus. This study was designed to assess whether type 1 diabetic children and adolescents with good metabolic control have early echocardiographic signs of subclinical left ventricular dysfunction and whether diabetes duration has any influence, using conventional and nonconventional echocardiographic tools.
A total of 100 patients with type 1 diabetes mellitus and 80 gender- and age-matched healthy controls were included. The cases underwent standard conventional transthoracic echocardiography, tissue Doppler imaging, and two-dimensional speckle tracking echocardiography. None of the diabetic patients had signs of renal, retinal, or neurological complications of the disease, and all were good metabolic control (mean HbA <7.5%).
There was no difference among groups in relation to age, sex, body mass index, and blood pressure. Conventional echocardiographic parameters were similar between diabetic and nondiabetic subjects except increased mitral valve peak A-wave and significantly lower mitral E/A ratio in diabetics. Diabetic patients had more advanced diastolic dysfunction with TDI analysis. In the diabetic group, left ventricular global longitudinal, circumferential, and radial strain and strain rate were significantly lower compared with the controls. There was a positive correlation between diabetes duration and cardiac dysfunction.
The results of this study showed that the diabetic children and adolescents with good metabolic control had diastolic dysfunction when assessed with either conventional or tissue Doppler echocardiography. Also diabetic patients had subclinical LV systolic dysfunction with a normal LVEF which can be detected with 2D speckle tracking echocardiography.
心脏功能障碍是糖尿病众所周知的后果。本研究旨在使用传统和非常规超声心动图工具，评估代谢控制良好的1型糖尿病儿童和青少年是否有亚临床左心室功能障碍的早期超声心动图迹象，以及糖尿病病程是否有任何影响。
共纳入100例1型糖尿病患者和80例性别及年龄匹配的健康对照者。病例接受标准的传统经胸超声心动图、组织多普勒成像和二维斑点追踪超声心动图检查。所有糖尿病患者均无该疾病的肾脏、视网膜或神经并发症迹象，且代谢控制良好（平均糖化血红蛋白<7.5%）。
各组在年龄、性别、体重指数和血压方面无差异。糖尿病患者和非糖尿病患者的传统超声心动图参数相似，只是糖尿病患者二尖瓣A波峰值增加，二尖瓣E/A比值显著降低。通过组织多普勒成像分析，糖尿病患者舒张功能障碍更严重。在糖尿病组中，与对照组相比，左心室整体纵向、圆周和径向应变及应变率显著降低。糖尿病病程与心脏功能障碍之间存在正相关。
本研究结果表明，代谢控制良好的糖尿病儿童和青少年，无论是通过传统超声心动图还是组织多普勒超声心动图评估，均存在舒张功能障碍。此外，糖尿病患者存在亚临床左心室收缩功能障碍，左心室射血分数正常，二维斑点追踪超声心动图可检测到这种情况。
