title: Early changes in cardiovascular structure and function in adolescents with type 1 diabetes.
abstract: BACKGROUND
  Children with type 1 diabetes (T1D) are at higher risk of early adult-onset cardiovascular disease. We assessed cardiovascular structure and function in adolescents with T1D compared with healthy controls and the relationships between peripheral vascular function and myocardial parameters.
  
  
  RESULTS
  199 T1D [14.4 ± 1.6 years, diabetes duration 6.2 (2.0-12.8) years] and 178 controls (14.4 ± 2.1 years) completed endothelial function by flow mediated vasodilatation (FMD), arterial stiffness using pulse wave velocity (PWV) along with M-mode, pulse wave and tissue Doppler, and myocardial deformation echocardiographic imaging. Systolic (113 ± 10 vs. 110 ± 9 mmHg; p = 0.0005) and diastolic (62 ± 7 vs. 58 ± 7 mmHg; p < 0.0001) blood pressures, carotid femoral PWV and endothelial dysfunction measurements were increased in T1D compared with controls. Systolic and diastolic left ventricular dimensions and function by M-mode and pulse wave Doppler assessment were not significantly different. Mitral valve lateral e' (17.6 ± 2.6 vs. 18.6 ± 2.6 cm/s; p < 0.001) and a' (5.4 ± 1.1 vs. 5.9 ± 1.1 cm/s; p < 0.001) myocardial velocities were decreased and E/e' (7.3 ± 1.2 vs. 6.7 ± 1.3; p = 0.0003) increased in T1D. Left ventricular mid circumferential strain (-20.4 ± 2.3 vs. -19.5 ± 1.7 %; p < 0.001) was higher, whereas global longitudinal strain was lower (-19.0 ± 1.9 vs. -19.8 ± 1.5 % p < 0.001) in T1D.
  
  
  CONCLUSIONS
  Adolescents with T1D exhibit early changes in blood pressure, peripheral vascular function and left ventricular myocardial deformation indices with a shift from longitudinal to circumferential shortening. Longitudinal follow-up of these changes in ongoing prospective trials may allow detection of those most at risk for cardiovascular abnormalities including hypertension that could preferentially benefit from early therapeutic interventions.
authors.affiliation: Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada. tjb1964@icloud.com.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bradley
authors.affiliation: Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada. cameron.slorach@sickkids.ca.
authors.forename: Cameron
authors.initials: C
authors.lastname: Slorach
authors.affiliation: Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada. farid.mahmud@sickkids.ca.
authors.forename: Farid H
authors.initials: FH
authors.lastname: Mahmud
authors.affiliation: Department of Pediatrics, University of Cambridge, Cambridge, UK. dbd25@cam.ac.uk.
authors.forename: David B
authors.initials: DB
authors.lastname: Dunger
authors.affiliation: University College Hospital, London, UK. j.deanfield@ich.ucl.ac.uk.|Heart Hospital and Great Ormond Street Hospital, London, UK. j.deanfield@ich.ucl.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada. livia.deda@sickkids.ca.
authors.forename: Livia
authors.initials: L
authors.lastname: Deda
authors.affiliation: Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada. yesmino.elia@sickkids.ca.
authors.forename: Yesmino
authors.initials: Y
authors.lastname: Elia
authors.affiliation: Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada. ronniehar@gmail.com.
authors.forename: Ronnie L H
authors.initials: RL
authors.lastname: Har
authors.affiliation: Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada. wei.hui@sickkids.ca.
authors.forename: Wei
authors.initials: W
authors.lastname: Hui
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada. rahim.moineddin@sickkids.ca.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada. heather.reich@uhn.ca.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Reich
authors.affiliation: Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada. james.scholey@uhn.ca.
authors.forename: James W
authors.initials: JW
authors.lastname: Scholey
authors.affiliation: Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada. luc.mertens@sickkids.ca.
authors.forename: Luc
authors.initials: L
authors.lastname: Mertens
authors.affiliation: Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada. etienne.sochett@sickkids.ca.
authors.forename: Etienne
authors.initials: E
authors.lastname: Sochett
authors.affiliation: Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada. david.cherney@uhn.ca.
authors.forename: David Z I
authors.initials: DZ
authors.lastname: Cherney
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001794:Blood Pressure; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D018450:Disease Progression; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D009200:Myocardial Contraction; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D012307:Risk Factors; D013314:Stress, Mechanical; D059289:Vascular Stiffness; D014664:Vasodilation; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left