Subclinical Left Ventricular Longitudinal Systolic Dysfunction in Paediatric Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract

There is large heterogeneity within the reports of subclinical myocardial insults in paediatric patients with type one diabetes mellitus (T1DM). We aimed to compare myocardial strain values of the left ventricle (LV) in asymptomatic paediatric patients with T1DM and healthy controls. Five databases were searched from inception to March 30, 2020, and studies that reported LV global longitudinal strain (LVGLS) values using two-dimensional speckle tracking echocardiography (2D-STE) in asymptomatic T1DM paediatric patients and control groups were included. The pooled mean strain values for LVGLS and LV global circumferential strain (LVGCS) were analysed in both groups. Ten studies (755 T1DM, 610 controls) with LVGLS were included, and 6 of these studies analysed LVGCS (534 T1DM, 403 controls). Paediatric patients (mean age 12.8±2.6 yrs) with T1DM had a pooled 3 percentage point reduction in LVGLS compared to control patients (18.4%, [95% CI 17.1, 19.6] vs 21.5% [20.3, 22.7], MD = - 3.01 [-4.30, -1.71]). Similar results were appreciated in LVGCS however this was not statistically significant (18.7% [15.4, 22.0] vs 21.4% [18.1, 24.6], MD = -3.10 [-6.47, 0.26]). Meta-regression recognised that those with higher Haemoglobin A1c (HbA1c) had worse LVGLS. Subclinical LV dysfunction among patients with T1DM occurs as early as in their childhood, while even EF is preserved. The longitudinal cardiac function is altered, but not the circumferential. GLS can be used to detect subclinical LV systolic dysfunction in paediatric population.