Tissue Doppler imaging is a sensitive echocardiographic technique to detect subclinical systolic and diastolic dysfunction of both ventricles in type 1 diabetes mellitus.
BACKGROUND
Subclinical left (LV) and right ventricular (RV) dysfunction has been demonstrated in type 2 diabetes mellitus and evidence indicates impaired LV diastolic function in type 1 diabetes mellitus (T1DM) as well. The aim of our study was to evaluate the role of tissue Doppler imaging (TDI) in assessment of global LV and RV function in T1DM patients.


METHODS
A detailed two-dimensional, pulsed wave Doppler and pulsed wave TDI analysis was performed in 53 normotensive middle-aged T1DM patients and compared to healthy controls.


RESULTS
In T1DM patients TDI analysis revealed reduced mean mitral septal and lateral E' velocities as well as reduced mean tricuspid E˙t velocity compared to healthy controls (E'sept 8.89 ± 1.89 cm/s vs. 11.50 ± 2.41 cm/s, p < 0.001; E'lat 12.29 ± 2.58 cm/s vs.15.30 ± 2.95 cm/s, p < 0,001; E't 13.56 ± 2.91 cm/s vs. 15.60 ± 2.99 cm/s, p = 0.001). Mean ratios E/E'sept, E/E'lat and E/E't were significantly higher in diabetics with cutoff value of 7.4 for E/E'sept and 3.4 for E/E't, differentiating diabetics with LV and RV diastolic impairement from matched healthy controls (sensitivity 76.5 %, specificity 73.8 % for E/E'sept and sensitivity 72.1 %, specificity 66.7 % for E/E't). Myocardial acceleration during isovolumetric contraction (IVA) measured at the septal mitral (LV IVA) and lateral tricuspid annulus (RV IVA) was the only parameter indicating reduced contractility of both ventricles in diabetics compared to controls (LV IVA 230.70 ± 61.26 cm/s(2) vs. 283.32 ± 59.74 cm/s(2), p < 0,001; RV IVA 275.48 ± 68.08 cm/s(2) vs. 316.86 ± 80.95 cm/s(2), p = 0.011). LV IVA had better diagnostic accuracy than RV IVA to predict early contractile impairement in T1DM patients (area under the curve 0.758, p < 0.001 for LV IVA and 0.648, p = 0.017 for RV IVA).


CONCLUSIONS
TDI is essential to detect subclinical diastolic deterioration of both ventricles in T1DM patients. TDI-derived IVA might be useful to assess early systolic alterations of both ventricles in T1DM patients.
Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia. david.suran@hotmail.com.
David
D
Suran
Department of Medical Intensive Care, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
Andreja
A
Sinkovic
Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
Franjo
F
Naji
D000328:Adult; D019540:Area Under Curve; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
Diabetes mellitus type 1; Left ventricular dysfunction; Right ventricular dysfunction; Tissue Doppler imaging