Van Ryckeghem Lisa, Franssen Wouter M A, Verbaanderd Elvire, Indesteege Jonas, De Vriendt Friedelinde, Verwerft Jan, Dendale Paul, Bito Virginie, Hansen Dominique
Faculty of Rehabilitation Sciences, Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium; Faculty of Medicine and Life Sciences, Biomedical Research Centre, Hasselt University, Diepenbeek, Belgium.
Faculty of Rehabilitation Sciences, Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium; Faculty of Medicine and Life Sciences, Biomedical Research Centre, Hasselt University, Diepenbeek, Belgium.
Can J Diabetes. 2021 Dec;45(8):718-724.e1. doi: 10.1016/j.jcjd.2021.01.010. Epub 2021 Jan 23.
Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in adolescents with T1D, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity.
Transthoracic echocardiography was performed in 19 adolescents with T1D (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO).
VO and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration.
Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young patients with T1D may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and, therefore, improve long-term cardiovascular health.
心血管疾病和运动不耐受会增加1型糖尿病（T1D）患者的死亡率。T1D青少年患者的左心室收缩和舒张功能已经受到影响，表现为血糖控制不佳（糖化血红蛋白[A1C]>7.5%）和运动不耐受。我们研究了疾病严重程度/病程对左心室功能的影响程度，以及这是否与运动能力相关。
对19名T1D青少年（14.8±1.9岁，A1C 7.4±0.9%）和19名对照者（14.4±1.3岁，A1C 5.3±0.2%）进行经胸超声心动图检查，两组在年龄和坦纳分期上相匹配。评估舒张和收缩（射血分数[EF]）功能。采用心肺运动试验评估运动能力，通过峰值摄氧量（VO）进行测量。
两组的VO以及左心室收缩和舒张功能相似。在T1D组中，EF与病程呈负相关（校正年龄、标准化体重指数、血糖变异性和VO后，r=-0.79；p=0.011）。回归分析显示，EF变异的37.6%可归因于病程。
尽管具有足够运动能力的T1D患者左心室收缩和舒张功能得以保留，但病程会对EF产生负面影响。至少在青春期，T1D的有害影响似乎是由病程而非疾病严重程度驱动的。因此，T1D年轻患者可能受益于心血管评估，以便在疾病早期检测到心血管异常，从而改善长期心血管健康。
