title: Early myocardial impairment in type 1 diabetes patients without known heart disease assessed with tissue Doppler echocardiography: The Thousand & 1 study.
abstract: Cardiovascular disease is the most common cause of mortality in type 1 diabetes; patients with albuminuria are at greatest risk. We investigated myocardial function and premature myocardial impairment in type 1 diabetes patients with and without albuminuria compared to controls.
  
  
  
  This study included a cross-sectional survey of 1093 type 1 diabetes patients from Steno Diabetes Center and 200 healthy controls. Conventional and tissue Doppler echocardiographic measurements were analysed in multivariable models in normoalbuminuria (n = 760), microalbuminuria (n = 227) and macroalbuminuria (n = 106). Investigators were blinded to degree of albuminuria.
  
  
  
  For the type 1 diabetes patients, mean age was 49.6 years, 53% were men and mean diabetes duration was 25.5 years. In multivariable models systolic velocity s' did not differ between type 1 diabetes patients with normoalbuminuria and controls (β-coefficient [95% confidence interval]: -0.17 [-0.41; 0.08], p = 0.19), but was impaired between controls and microalbuminuria (-0.53 [-0.84; -0.23], p = 0.001) and macroalbuminuria (-0.59 [-0.96; -0.22], p = 0.002). Diastolic measurements (e', a', e'/a', and E/e') were all significantly impaired in type 1 diabetes, for example, e'/a': normoalbuminuria, microalbuminuria and macroalbuminuria versus controls: -0.38 [-0.52; -0.23], p < 0.001; -0.49 [-0.67; -0.32], p < 0.001; and -0.81 [-1.03; -0.59], p < 0.001. In age-related analyses, myocardial impairment occurred prematurely in type 1 diabetes compared to controls (e.g. E/e' = 8; 9.2 years [normoalbuminuria], 17.3 years [microalbuminuria] and 41.4 years [macroalbuminuria] prematurely, respectively).
  
  
  
  In type 1 diabetes patients with albuminuria, both systolic and diastolic functions are impaired, whereas in patients without albuminuria only diastolic function is affected. Myocardial impairment is detectable many years prematurely in type 1 diabetes, especially in patients with albuminuria.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Steno Diabetes Center, Gentofte, Denmark Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark magnustjensen@gmail.com.
authors.forename: Magnus Thorsten
authors.initials: MT
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Sogaard
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Henrik Ullits
authors.initials: HU
authors.lastname: Andersen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Department of Cardiology, Hospital Hvidovre, University of Copenhagen, Hvidovre, Denmark.
authors.forename: Ida
authors.initials: I
authors.lastname: Gustafsson
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Bech
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Thomas Fritz
authors.initials: TF
authors.lastname: Hansen
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Simone
authors.initials: S
authors.lastname: Theilade
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark Department of Internal Medicine, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Almdal
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Faculty of Health, Aarhus University, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003718:Denmark; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Type 1 diabetes; albuminuria; echocardiography; heart disease; prevention; tissue Doppler imaging