Evaluation of Left Atrial Function and Cardiac Autonomic Dysfunction in Pediatric Patients with Type 1 Diabetes Mellitus

Abstract

Type 1 Diabetes mellitus (DM) is associated with the development of cardiovascular disease. In this study we aimed to determine left atrial function with two-dimensional speckle tracking echocardiography (2D-STE) and to identify cardiac autonomic dysfunction with P wave analysis in pediatric patients with Type 1 Diabetes Mellitus (DM). 63 patients and 36 healthy controls were included in the study. Conventional transthoracic echocardiography, left atrial 2D-STE, and 12-lead surface electrocardiography were performed in all patients. The LA strain (LA S) parameters: systolic [LA S-S], early diastolic [LA S-E], and late diastolic [LA S-A] strains were assessed. The LAV index (LAVI) was calculated as LAV divided by body surface area. Maximum P wave duration (Pmax), minimum P wave duration (Pmin) and P wave dispersion (Pdis) were measured from the 12-lead electrocardiogram. The LA S-S ([39.91±9.08 vs 45.88±8.85], p= 0.018), LA S-E ([26.86±7.54 vs 29.77±7.65], p= 0.012 ), and LA S-A ([13.43±4.68 vs 15.82±5.02], p= 0.022), E/A wave ratio ([1.76±0.37 vs 2.11±0.34], p= 0.024) values were significantly lower, the mean LAVI (ml/m2) ([26.10±2.81 vs 23.53±2.04], p= 0.028) and mitral valve A wave velocity ([0.58±0.14 vs 0.50±0.10], p= 0.032) were found to be higher in the patient group compared to the control group. Pdis and Pmax intervals were significantly longer in the patient group. 2D-STE showed impaired atrial function in pediatric patients with type 1 DM, in this patients may develop cardiac autonomic dysfunction. This may be diagnosed on ECG even when the patients are asymptomatic.