Evaluation of left ventricular diastolic and systolic function in children with type 1 diabetes mellitus using echocardiography and tissue Doppler imaging

Abstract

Background It has been shown that children with type 1 diabetes mellitus (T1DM) have high incidence of heart failure even in the absence of ischemic, hypertensive, or valvular heart disease. Most of these children have normal or even hyper-dynamic left ventricular (LV) systolic function at rest, whereas the diastolic function, particularly relaxation, is impaired. Tissue Doppler echocardiography measures myocardial motion and velocity, which provide a useful tool for defining subtle systolic and diastolic dysfunction. Objective To assess the LV systolic and diastolic functions in children with type 1 diabetes mellitus attending the Alexandria University Children’s Hospital and its relation to the glycemic control and duration of the disease. Patients and methods The study was conducted on 40 patients with T1DM who were followed up at the diabetes clinic of the Alexandria University Children’s Hospital and 20 apparently healthy control children of matched age and sex. Cardiac functions were assessed by conventional Doppler echocardiography and tissue Doppler imaging (TDI). Results The results showed early cardiomyopathic changes in the form of diastolic dysfunction and impaired relaxation by studying the E/A ratio using conventional Doppler mitral flow in 7.5% of the diabetic children, whereas by using pulsed TDI, we found diastolic dysfunction of the septal or medial segment of the LV in 52.5%, and of the lateral segment in 42.2% of the diabetic patients. Moreover, the mean peak pulsed Doppler Am velocity was significantly higher in diabetic patients than in controls. There was a significant negative correlation between the duration of diabetes and E/A ratio. A significant negative correlation was found also between the LV diastolic dysfunction and the duration of the diabetes, whereas no significant correlation was found with the glycated hemoglobin% or age of the patients. The systolic function was normal in our diabetic patients. Conclusion Our diabetic patients are in need of better glycemic control and periodic echocardiographic assessments, particularly by TDI to monitor the progression of subclinical ventricular dysfunction and to guard against the development of congestive heart failure.