Self-reported dyspnea is associated with impaired global longitudinal strain in ambulatory type 1 diabetes patients with normal ejection fraction and without known heart disease - The Thousand & 1 Study

Abstract

Aims: Identification of early signs and symptoms of heart disease is important in type 1 diabetes (T1DM). Global longitudinal strain (GLS) by speckle-tracking echocardiography can detect subtle impairments in myocardial function. We investigated the association between myocardial function and degree of dyspnea in patients with normal left ventricular ejection fraction (LVEF) and without known heart disease.

Methods: Ambulatory patients from Steno Diabetes Center. Conventional echocardiography and GLS was performed. Patients reported degree of dyspnea according to the NYHA classification. Patients with LVEF≤45% were excluded. Data were analyzed in uni-and multivariable models.

Results: A total of 1075 T1DM patients were included. Mean age 49.5years, 52% men, mean diabetes duration 25.8years; 835 (77.7%) reported no dyspnea, 156 (14.5%) NYHA I, 68 (6.3%) NYHA II, and 16 (1.5%) NYHA III-IV. LVEF did not differ between groups of dyspnea in neither univariable nor multivariable models (p>0.1). E/e' was associated with degree of dyspnea in both univariable (p<0.001) and multivariable models (p=0.048). GLS was associated with degree of dyspnea in a dose-response relationship in both univariable (p<0.001) and multivariable models (p<0.001).

Conclusions: Degree of dyspnea is independently associated with impaired myocardial function by GLS in T1DM patients with normal LVEF and without known heart disease.

Keywords: Diabetes mellitus; Echocardiography; Prevention; Speckle-tracking; Strain.