title: Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study.
abstract: Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p = 0.019) and circumferential (p = 0.016) strain rate both at rest and during exercise (p = 0.021). This was more pronounced in T1DM patients with a longer disease duration (p = 0.038). T1DM patients with serum HbA1c > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) and a reduced E/A-ratio (p = 0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment.
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
authors.forename: Kai O
authors.initials: KO
authors.lastname: Hensel
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Grimmer
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Roskopf
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Jenke
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirth
authors.affiliation: Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heusch
mesh_terms: D000293:Adolescent; D000367:Age Factors; D058070:Asymptomatic Diseases; D001642:Bicycling; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013314:Stress, Mechanical; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
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