0318 : Left ventricular diastolic dysfunction in asymptomatic type 1 diabetic children: two-dimensional echocardiography study

Abstract

Diabetic cardiomyopathie (DCM) is a distinct new entity. Pathophysiological mechanisms are not well known. It's defined as the presence of abnormal myocardial performance or abnormal structure in the absence of epicardial coronary artery disease, hypertension and significant valvular disease. The relationship between type 1 diabetes (T1D) and cardiac function in children is not well established. Demonstration of an early diastolic and systolic dysfunction help us to diagnose children's DCM, and is important for the timely interventions. The objective of this study was to characterize diastolic function abnormalities using two-dimensional echocardiography in T1D children. Twenty four T1D children were compared to 20 healthy control matched for age, gender and body mass index and having normal echocardiography. A standard 12-lead electrocardiogram was recorded followed by measurement of blood pressure. Laboratory investigations included mean hemoglobin (HbA1c). Echocardiography with simultaneous ECG (standard lead II), including standard echocardiographic views and tissue Doppler imaging (TDI), was performed using Vivid 9, GE Ultrasound. Left ventricular end-diastolic diametre (LV-EDD), interventricular septal end-diastolic diametre (IVS-EDD) were measured. LV conventional Doppler parameters of diastolic function were obtained: peak early (E) and peak late (A) diastolic flow velocities, E-wave deceleration time and E/A ratio were measured on the basis of transmitral flow velocities. LVEF was assessed using the biplane Simpson's method in apical four and two chamber views. TDI was performed in four apical view. The following TDI variables were evaluated: peak systolic (S), peak early diastolic (E’) and peak late diastolic (A). The mean age was 11.13 years±0.54. The T1D children and control group were comparable with respect to age, gender and heart rate. Diabetic children were asymptomatic and had normal physical examination. The mean duration of diabetes was 7±0.54 years. The mean HbA1C was 8.79%±0.25. LVEDD was 41.8±0.84 mm and LVESD was 26.33±0.73 mm. The average of IVS was 5.5±0.19 mm. LVEF was preserved with an average of 67.88±1.18%. The left atrial area was 10.78±0.33 and the volume was 24.35±1.72 ml. For diastolic function, in the diabetic group, E wave was 1.07±0.03cm/s, A wave was 0.58±0.04cm/s and E/A ratio was 4.4±2.08. In the control group, the E wave was 1.04±0.01cm/s, the A wave was 0.59±0.14 and the E/A ratio of 1.78±0.046. There were no significant differences between the two groups. The TDE was however significantly shorter in the diabetic group 146.54±3.69 ms Vs 161.42 ms±2.38 for the control group, with p = 0.005. Similarly, E ’septal wave were significantly decreased in diabetic children compared to controls (0.16±0.006 Vs 0.20±0.007, p = 0.001). The E / E ’ ratio was significantly higher in the diabetic group compared to the control group (6.72±0.33 vs. 5.21±0.15, p = 0.0011). Subclinical left ventricular impairment has been well demonstrated. Our study showed that diastolic function is affected whereas the parameters of systolic function are still preserved. The author hereby declares no conflict of interest