In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Type 1 Diabetes Mellitus Using Layer-Specific Strain Analysis

Abstract

Background: Although the subclinical left ventricular (LV) dysfunction caused by diabetes mellitus (DM) results in a high risk of death and heart failure, the details of cardiac dysfunction across a wide age range remain unclear. The aim of this study was to assess LV dysfunction in patients with type 1 DM (T1DM) using layer-specific strain analysis by echocardiography. Methods and Results: The 52 patients (median age: 23 [range: 5-40] years) with T1DM were divided into 3 age groups (D1: 5-14 years, D2: 15-24 years, D3: 25-40 years); 78 age-and sex-similar controls were divided into 3 corresponding groups (C1, C2, and C3). Layer-specific longitudinal strain (LS) and circumferential strain (CS) of the 3 myocardial layers (endocardium, midmyocardium, and epicardium) were determined using echocardiography. Strains did not decrease in D1. Epicardial and midmyocardial CS at the basal level and LS in all layers were decreased in D2 compared with C2. CS at the basal level and LS in all layers were lower in D3 than in C3. The strains correlated with the duration of T1DM and LV wall thickness. Conclusions: In patients with T1DM, longitudinal deformation in all layers and epicardial and midmyocardial circumferential deformation at the basal level decreased from the late teens, which correlated with the duration of the disease and LV hypertrophy.

Left atrial dysfunction and stiffness in pediatric and adult patients with Type 1 diabetes mellitus assessed with speckle tracking echocardiography

“…In a previous study, we reported that LV longitudinal and circumferential strain at the basal level were useful and sensitive indicators of cardiac dysfunction caused by T1DM compared with the conventional parameters 42 . Further studies are needed to determine which parameters are useful as early and accurate indicators of cardiac dysfunction.…”

“…In addition, this may reflect the young age of the participants and the short duration of the disease in our study as well as the fact that their diabetes appeared to be under fairly good control. As an indicator of short‐term hyperglycemia, HbA1c cannot show the relationship between glycemic control and cardiac function in diabetic patients with long disease durations 42 …”

Assessment of subclinical diabetic cardiomyopathy by speckle‐tracking imaging

“…Subclinical systolic dysfunction was predominantly assessed using 2D STE parameters: GLS was measured in most of the cases, but global circumferential (GCS) and radial (GRS) strains were also measured in some of the included studies 4,7,8,16,21‐25 (Table 1). Furthermore, few studies also used 3D STE 1,7,26 and multiple‐layer strain 5,8,21,27‐30 for systolic function assessment. Systolic dysfunction was correlated with lower absolute values of GLS, GCS or GRS, 4,7 GLS being independently associated with cardiovascular events, short‐ and long‐term hospital mortality, all‐cause death and hospitalization 1,5,14,17,18,21,31‐33 .…”

Echocardiographic parameters according to insulin dose in young patients affected by type 1 diabetes

“…A second mechanism could be related to cardiac hypertrophy, one of the first structural changes in the diabetic cardiomyopathy [22]. Insulin resistance, hyperactivity of the sympathetic system and hyperinsulinemia were all linked to cardiac hypertrophy [23]. Altered IVRT may be a precocious alteration in the development of cardiac hypertrophy [24].…”