title: Prevalence, predictors and evolution of echocardiographically defined cardiac abnormalities in adults with type 1 diabetes: an observational cohort study.
abstract: OBJECTIVE
  The aims of this observational study were to determine the prevalence and predictors of an abnormal echocardiogram in adults with type 1 diabetes, and to assess the evolution of changes in a subset of subjects.
  
  
  METHODS
  Cardiac function and structure were prospectively investigated by comprehensive transthoracic echocardiographic techniques in asymptomatic adults with type 1 diabetes seen in the ambulatory care setting.
  
  
  RESULTS
  We recruited 136 subjects (mean age 39 years, SD 14 years) with a median diabetes duration of 21 years [25(th), 75(th) interquartile range; 11, 29]. An abnormal echocardiogram was present in 29% of subjects; diastolic dysfunction in 69%, left ventricular hypertrophy in 38% and systolic dysfunction in 10%. The independent predictors of an abnormal echocardiogram were age, with a 9-fold increase in those ≥40 years (OR 9.40 [95% CI 2.68-33.04], P <0.0001), and increased body mass index (BMI), with a 17% increase in risk (P=0.04). A second echocardiogram was available in 65 subjects (3.8±1.7 years later). The results showed that one in five with a normal first study had developed an abnormal second study, mainly diastolic dysfunction, with age being the only independent predictor of progression (P=0.006).
  
  
  CONCLUSIONS
  Subclinical echocardiographic abnormalities are common in asymptomatic type 1 diabetes adults, and changes are progressive. The addition of an echocardiogram to complication surveillance programs in those with type 1 diabetes aged ≥40 years may represent a cost-effective way to screen for, and aggressively treat, occult cardiac disease.
authors.affiliation: Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Bryan
authors.initials: B
authors.lastname: Wai
authors.affiliation: Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ord
authors.affiliation: Department of Endocrinology & Diabetes, St Vincent's Hospital & University of Melbourne, Melbourne, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: MacIsaac
authors.affiliation: Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Endocrine Centre of Excellence, Austin Health, Melbourne, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Jerums
authors.affiliation: Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Piyush M
authors.initials: PM
authors.lastname: Srivastava
authors.affiliation: Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia. Electronic address: l.burrell@unimelb.edu.au.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Burrell
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology
keywords: Cardiac disease; Diastolic dysfunction; Echocardiography; Left ventricular hypertrophy; Type 1 diabetes mellitus