Evaluation of Cardiac Functions in Children and Adolescents with Type 1 Diabetes

Abstract

BackgroundCardiac dysfunction in patients with type 1 diabetes (T1D) represents one of the serious complications. To evaluate the cardiac function in children with T1D by conventional echocardiography and tissue Doppler imaging (TDI).MethodsThe study included 40 T1D patients (age between 6 and 16 years) with > 5 years duration of diabetes and 42 healthy control children. The patients were subjected to clinical evaluation and laboratory investigations [glycosylated hemoglobin A1c (HbA1c), serum lipids and lipoproteins]. Conventional echocardiography and TDI were performed to patients and controls.ResultsThe patients had lower early diastolic filling velocity (E wave) of the tricuspid valve and mitral valves with a p value of (0.000 and 0.006, respectively). TDI revealed that patients had lower S′velocity of the T1D, shorter isovolumic contraction time, longer isovolumic relaxation time and lower E/E′ of the right ventricle than controls (p value 0.002, 0.001, 0.004, 0.003, and 0.016, respectively). The left ventricle (LV)-T1D of the patients was significantly higher (p value 0.02). Twenty eight patients had poor glycemic control without significant differences between them and those with good glycemic control regarding echocardiographic data. Patients with dyslipidemia (13 patients) had higher late diastolic filling velocity of the mitral valve (A) and the lower LV late tissue velocity (A′) (p wave 0.047 and 0.015). No correlation existed between the duration of illness or the level of HbA1c and the echocardiographic parameters.ConclusionDiabetic children have evidence of echocardiographic diastolic dysfunctions. Periodic cardiac evaluation with both conventional and tissue Doppler echocardiography is recommended for early detection of this dysfunction.

Role of epicardial fat thickness and irisin levels in early prediction of cardiac dysfunction in children and adolescents with type 1 diabetes mellitus

“…As epicardial fat has been shown to be a form of visceral adipose tissue, these authors suggested it to be a metabolic and cardiovascular risk factor. Left atrial diameter was significantly increased in accordance with Abd-El Aziz et al and Flachskampf et al [16,17]. They mentioned that an enlarged left atrium is a sign of increased left atrial pressure which has developed over time.…”

Diastolic function evaluation in children with ventricular arrhythmia

“…IVRT was also found to be elongated in our population, which, to the best of our knowledge, was never described in the literature concerning PVC in children. Its increase relates to early diastolic dysfunction in many diseases such as hypertrophic cardiomyopathy, arterial hypertension, or diabetes 21,22 In PVC children, it is the consequence of dyssynchronous contraction due to arrhythmia, which leads in a natural way to dyssynchronous relaxation. The dyssynchronous myocardial activation is seen not only when a premature beat occurs but also during sinus rhythm neighboring the premature contraction 23 .…”

Advanced Glycation End Products: New Clinical and Molecular Perspectives

“…They are mostly the leading cause of death among diabetic patients, representing 50% of the deaths related to this disease [ 27 ]. Diabetic cardiomyopathy is characterized by ventricular dysfunction originating from myocyte hypertrophy [ 71 , 72 ] and myocardial fibrosis [ 73 ]. The AGE–RAGE axis has been admitted as one of the contributing factors to this incompletely elucidated chronic complication ( Figure 4 ) [ 29 ].…”