title: The influence of real-time blood glucose levels on left ventricular myocardial strain and strain rate in pediatric patients with type 1 diabetes mellitus - a speckle tracking echocardiography study.
abstract: BACKGROUND
  Echocardiographic myocardial performance parameters such as strain and strain rate are increasingly used to assess systolic and diastolic function in patients with diabetes mellitus and several other clinical and scientific scenarios. While long-term metabolic marks such as HbA1C are inherently assessed in diabetic patients, the actual blood glucose level at the very moment of the echocardiographic study has not yet been taken into account for the assessment of cardiac mechanics. The aim of this study was to investigate the influence of real-time blood glucose levels on left ventricular (LV) myocardial strain and strain rate in pediatric patients with type 1 diabetes mellitus (T1DM).
  
  
  METHODS
  We performed speckle tracking echocardiography on 39 normotensive pediatric patients with uncomplicated type 1 diabetes mellitus (mean age 11.5 ± 3.5 years, 40 % female) and 44 sex- and age-matched healthy controls (mean age 11.4 ± 2.9 years, 45 % female). T1DM patients were sub-categorized according to their blood sugar levels (with a cutoff of 150 mg/dL) at the moment of the echocardiographic exam. Investigators were blinded to the participants' study group status.
  
  
  RESULTS
  Interestingly, diabetic patients with higher blood sugar levels demonstrated significantly increased LV circumferential strain (p = 0.003) and strain rate (p = 0.005) as well as global longitudinal strain rate (p = 0.002) in comparison to T1DM patients with lower blood sugar levels or healthy controls.
  
  
  CONCLUSIONS
  For the investigation of myocardial performance with sensitive methods such as speckle tracking echocardiography in diabetic study populations real-time blood sugar levels should be taken into account. Further studies are needed to verify these findings in large-scale patient cohorts and serial intra-individual measurements in different metabolic states.
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany. kai.hensel@uni-wh.de.
authors.forename: Kai O
authors.initials: KO
authors.lastname: Hensel
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany. franziska.grimmer@uni-wh.de.
authors.forename: Franziska
authors.initials: F
authors.lastname: Grimmer
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany. andreas.jenke@eko.de.
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Jenke
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany. stefan.wirth@helios-kliniken.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirth
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany. andreas.heusch@uni-wh.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heusch
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose