Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings.
OBJECTIVE
To evaluate the relationship between 24-h blood pressure (BP) measurements and diastolic heart function evaluated by Doppler tissue imaging and B-type natriuretic peptide (BNP) levels in children with type 1 diabetes mellitus (DM).


METHODS
A total of 32 diabetic and 18 healthy children were enrolled. Spectral Doppler analysis and tissue Doppler measurements were performed by conventional echocardiography. The 24-h ambulatory BP and serum BNP levels were measured.


RESULTS
Analysis of ambulatory blood pressure monitoring (ABPM) recordings showed that median daytime diastolic BP load were significantly higher in diabetic patients compared to controls [12.35 (4.23-27.23) vs. 2.5 (0-8.7), p = 0.007]. Patients with elevated daytime systolic and diastolic BP loads had significantly higher BNP values compared to patients with normal BP load (31.4 ± 24.36 vs. 11.84 ± 11.25 pg/mL, p = 0.03 and 23.21 ± 15.12 vs. 12.12 ± 14.65 pg/mL, p = 0.03, respectively). Isovolemic contraction time (47.43 ± 7.84 vs. 42.27 ± 7.47, p = 0.045), isovolemic relaxation time (68.84 ± 10.43 vs. 58.77 ± 10.02, p = 0.02), and myocardial performance index (0.45 ± 0.10 vs. 0.37 ± 0.09, p = 0.02) as determined by tissue Doppler echocardiography were significantly high in diabetic patients compared to that of control cases. Ratio of mitral peak early diastolic flow velocity (E) to peak early diastolic myocardial velocities by tissue Doppler echocardiography (E') was also higher in patients with elevated daytime systolic BP load (E/E', 6.71 ± 1.97 vs. 4.91 ± 1.02, p = 0.04).


CONCLUSIONS
Elevated BP loads detected by 24-h ambulatory BP measurements in children with type 1 diabetes are associated with increased BNP levels and abnormal tissue Doppler echocardiography indices, indicating early stage cardiac dysfunction.
Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Mustafa
M
Kır
Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Benhur
B
Cetin
Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Korcan
K
Demir
Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Nuh
N
Yılmaz
Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Ozgur
O
Kızılca
Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Tulay
T
Demircan
Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Nurettin
N
Unal
Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Ece
E
Bober
Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, 35340, Turkey.
Gul Sagin
GS
Saylam
D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003971:Diastole; D042241:Early Diagnosis; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
D020097:Natriuretic Peptide, Brain
ambulatory blood pressure; diabetic children; diastolic function