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Observational Study
. 2016 Feb 16:15:31.
doi: 10.1186/s12933-016-0351-3.

Early changes in cardiovascular structure and function in adolescents with type 1 diabetes

Timothy J Bradley  1 , Cameron Slorach  2 , Farid H Mahmud  3 , David B Dunger  4 , John Deanfield  5   6 , Livia Deda  7 , Yesmino Elia  8 , Ronnie L H Har  9 , Wei Hui  10 , Rahim Moineddin  11 , Heather N Reich  12 , James W Scholey  13 , Luc Mertens  14 , Etienne Sochett  15 , David Z I Cherney  16
Affiliations
Observational Study

Early changes in cardiovascular structure and function in adolescents with type 1 diabetes

Timothy J Bradley et al. Cardiovasc Diabetol. .

Abstract

Background: Children with type 1 diabetes (T1D) are at higher risk of early adult-onset cardiovascular disease. We assessed cardiovascular structure and function in adolescents with T1D compared with healthy controls and the relationships between peripheral vascular function and myocardial parameters.

Methods and results: 199 T1D [14.4 ± 1.6 years, diabetes duration 6.2 (2.0-12.8) years] and 178 controls (14.4 ± 2.1 years) completed endothelial function by flow mediated vasodilatation (FMD), arterial stiffness using pulse wave velocity (PWV) along with M-mode, pulse wave and tissue Doppler, and myocardial deformation echocardiographic imaging. Systolic (113 ± 10 vs. 110 ± 9 mmHg; p = 0.0005) and diastolic (62 ± 7 vs. 58 ± 7 mmHg; p < 0.0001) blood pressures, carotid femoral PWV and endothelial dysfunction measurements were increased in T1D compared with controls. Systolic and diastolic left ventricular dimensions and function by M-mode and pulse wave Doppler assessment were not significantly different. Mitral valve lateral e' (17.6 ± 2.6 vs. 18.6 ± 2.6 cm/s; p < 0.001) and a' (5.4 ± 1.1 vs. 5.9 ± 1.1 cm/s; p < 0.001) myocardial velocities were decreased and E/e' (7.3 ± 1.2 vs. 6.7 ± 1.3; p = 0.0003) increased in T1D. Left ventricular mid circumferential strain (-20.4 ± 2.3 vs. -19.5 ± 1.7 %; p < 0.001) was higher, whereas global longitudinal strain was lower (-19.0 ± 1.9 vs. -19.8 ± 1.5 % p < 0.001) in T1D.

Conclusions: Adolescents with T1D exhibit early changes in blood pressure, peripheral vascular function and left ventricular myocardial deformation indices with a shift from longitudinal to circumferential shortening. Longitudinal follow-up of these changes in ongoing prospective trials may allow detection of those most at risk for cardiovascular abnormalities including hypertension that could preferentially benefit from early therapeutic interventions.

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Figures

Fig. 1
Fig. 1
Box and whisker plots of significant group differences in blood pressure and echocardiographic measurements between adolescents with type 1 diabetes and controls. Boxes represent inter-quartile ranges (IQR), the ends of the whisker are set at 1.5* IQR above the third quartile and 1.5* IQR below the first quartile, and the minimum or maximum outliers are only shown if outside this range
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