Lausanne University (UNIL), Faculty of Biology and Medicine, Lausanne, Switzerland.
Department of Radiology, Lausanne University Hospital (CHUV), Center for Biomedical Imaging, Lausanne, Switzerland.
PLoS One. 2020 Feb 13;15(2):e0228569. doi: 10.1371/journal.pone.0228569. eCollection 2020.
Type 1 diabetes mellitus (T1DM) in children and adolescents is associated with significant cardiovascular morbidity and mortality. Early detection of vascular dysfunction is key to patient management yet current assessment techniques are invasive and not suitable for pediatric patient populations. A novel approach using isometric handgrip exercise during magnetic resonance imaging (IHE-MRI) has recently been developed to evaluate coronary endothelial function non-invasively in adults. This project aimed to assess endothelium-dependent coronary arterial response to IHE-MRI in children with T1DM and in age matched healthy controls.
Healthy volunteers and children with T1DM (>5 years) were recruited. IHE-MRI cross-sectional coronary artery area measurements were recorded at rest and under stress. Carotid intima media thickness (CIMT) and aortic pulse wave velocity (PWV) were assessed for comparison. Student's t-tests were used to compare results between groups.
Seven children with T1DM (3 female, median 14.8 years, mean 14.8 ± 1.9 years) and 16 healthy controls (7 female, median 14.8 years, mean 14.2 ± 2.4 years) participated. A significant increase in stress-induced cross-sectional coronary area was measured in controls (5.4 mm2 at rest to 6.39 mm2 under stress, 18.8 ± 10.7%, p = 0.0004). In contrast, mean area change in patients with T1DM was not significant (7.17 mm2 at rest to 7.59 mm2 under stress, 10.5% ± 28.1%, p = n.s.). There was no significant difference in the results for neither PWV nor CIMT between patients and controls, (5.3±1.5 m/s vs.4.8±0.7 m/s and 0.4±0.03mm vs.0.46 mm ± 0.03 respectively, both p = n.s.).
Our pilot study demonstrates the feasibility of using a totally non-invasive IHE-MRI technique in children and adolescents with and without T1DM. Preliminary results suggest a blunted endothelium-dependent coronary vasomotor function in children with T1DM (>5 years). Better knowledge and new methodologies may improve surveillance and care for T1DM patients to reduce cardiovascular morbidity and mortality.
儿童和青少年 1 型糖尿病（T1DM）与显著的心血管发病率和死亡率相关。血管功能障碍的早期检测是患者管理的关键，但目前的评估技术具有侵入性，不适合儿科患者群体。一种新的方法是在磁共振成像（MRI）期间使用等长手握力运动（IHE-MRI）来无创评估成年人的冠状动脉内皮功能。该项目旨在评估 T1DM 儿童和年龄匹配的健康对照组中 IHE-MRI 对冠状动脉的内皮依赖性反应。
招募了健康志愿者和 T1DM 儿童（>5 岁）。在休息和应激时记录 IHE-MRI 冠状动脉横截面积测量值。评估颈动脉内膜中层厚度（CIMT）和主动脉脉搏波速度（PWV）进行比较。使用学生 t 检验比较组间结果。
7 名 T1DM 儿童（3 名女性，中位年龄 14.8 岁，平均 14.8 ± 1.9 岁）和 16 名健康对照组（7 名女性，中位年龄 14.8 岁，平均 14.2 ± 2.4 岁）参与了研究。在对照组中，应激诱导的冠状动脉横截面积显著增加（休息时 5.4mm2，应激时 6.39mm2，增加 18.8 ± 10.7%，p = 0.0004）。相比之下，T1DM 患者的平均面积变化不显著（休息时 7.17mm2，应激时 7.59mm2，增加 10.5% ± 28.1%，p = n.s.）。患者与对照组之间的 PWV 和 CIMT 结果均无显著差异（分别为 5.3±1.5m/s 和 4.8±0.7m/s，0.4±0.03mm 和 0.46mm ± 0.03，两者均 p = n.s.）。
我们的初步研究表明，在有和没有 T1DM 的儿童和青少年中使用完全无创的 IHE-MRI 技术是可行的。初步结果表明，T1DM（>5 岁）儿童的内皮依赖性冠状动脉血管舒缩功能受损。更好地了解和使用新方法可能会改善 T1DM 患者的监测和护理，以降低心血管发病率和死亡率。
