Global longitudinal strain is not impaired in type 1 diabetes patients without albuminuria: the Thousand & 1 study.
OBJECTIVE
The purpose of this study was to investigate if systolic myocardial function is reduced in all patients with type 1 diabetes (T1DM) or only in patients with albuminuria.


BACKGROUND
Heart failure is a common cause of mortality in T1DM, and a specific diabetic cardiomyopathy has been suggested. It is not known whether myocardial dysfunction is a feature of T1DM per se or primarily associated with diabetes with albuminuria.


METHODS
This cross-sectional study compared 1,065 T1DM patients without known heart disease from the outpatient clinic at the Steno Diabetes Center with 198 healthy control subjects. Conventional echocardiography and global longitudinal strain (GLS) by 2-dimensional speckle-tracking echocardiography was performed and analyzed in relation to normoalbuminuria (n = 739), microalbuminuria (n = 223), and macroalbuminuria (n = 103). Data were analyzed in univariable and multivariable linear regression models adjusted for confounding factors including conventional risk factors, medication, and systolic and diastolic dysfunction. Investigators were blinded to degree of albuminuria.


RESULTS
Mean age was 49.5 years, 52% men, mean glycated hemoglobin 8.2% (66 mmol/mol), mean body mass index 25.5 kg/m(2), and mean diabetes duration 26.1 years. In unadjusted analyses, GLS differed significantly between T1DM patients and control subjects (p = 0.02). When stratified by degrees of albuminuria, the difference in GLS compared with control subjects was -18.8 ± 2.5% versus -18.5 ± 2.5% for normoalbuminuria (p = 0.28), versus -17.9 ± 2.7% for microalbuminuria (p = 0.001), and versus -17.4 ± 2.9% for macroalbuminuria (p < 0.001). Multivariable analyses, including clinical characteristics, diastolic and systolic dysfunction, and use of medication, did not change this relationship.


CONCLUSIONS
Systolic function assessed by GLS was reduced in T1DM compared with control subjects. This difference, however, was driven solely by decreased GLS in T1DM patients with albuminuria. T1DM patients with normoalbuminuria have systolic myocardial function similar to healthy control subjects. These findings do not support the presence of specific diabetic cardiomyopathy without albuminuria.
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Steno Diabetes Center, Gentofte, Denmark. Electronic address: magnustjensen@gmail.com.
Magnus Thorsten
MT
Jensen
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Peter
P
Sogaard
Steno Diabetes Center, Gentofte, Denmark.
Henrik Ullits
HU
Andersen
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Jan
J
Bech
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Thomas
T
Fritz Hansen
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Tor
T
Biering-Sørensen
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Peter Godsk
PG
Jørgensen
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Søren
S
Galatius
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Jan Kyst
JK
Madsen
Steno Diabetes Center, Gentofte, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Faculty of Health, University of Aarhus, Aarhus, Denmark.
Peter
P
Rossing
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Jan Skov
JS
Jensen
D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged
albuminuria; diabetes mellitus; diabetic cardiomyopathy; echocardiography; heart failure; kidney