Retinopathy is associated with impaired myocardial function assessed by advanced echocardiography in type 1 diabetes patients - The Thousand & 1 Study.
OBJECTIVE
Retinopathy and heart disease in Type 1 Diabetes Mellitus (Type 1 DM) may be associated; however previous results have been conflicting. Tissue Doppler Imaging (TDI) and speckle-tracking echocardiography (STE) quantify myocardial function not assessable by conventional echocardiography. We investigated the association between severity of retinopathy and early myocardial dysfunction using conventional echocardiography, TDI and STE in Type 1 DM patients.


METHODS
Type 1 Diabetes Mellitus patients without known heart disease were included from the Steno Diabetes Center. The cross sectional association between retinopathy and myocardial function was analyzed in uni-and multivariable models. Retinopathy was categorized as nil-, simplex- or proliferative retinopathy.


RESULTS
A total of 1090 Type 1 Diabetes Mellitus patients were included, mean age was 49.6years and 53% were males. Left ventricular ejection fraction did not differ between groups of retinopathy. Global longitudinal strain (GLS) by STE decreased significantly with increasing degrees of retinopathy (nil; -18.6%, simplex; -18.2% (p=0.024), proliferative; -17.7% (p<0.001)), however differences attenuated in multivariable models (p⩾0.05). In univariable models, myocardial tissue velocities differed in relation to retinopathy: s' (nil; 6.9, simplex; 6.5, proliferative; 5.9 (p=0.001), e' (nil; 10.4, simplex; 9.2, proliferative; 7.9, p<0.001), a' (nil; 6.1, simplex; 6.7, proliferative; 7.0, p<0.001) and E/e' (nil; 6.7, simplex; 7.5, proliferative; 9.5, p<0.001). In multivariable models, differences persisted between nil and proliferative retinopathy for s', e' and E/e'.


CONCLUSIONS
Proliferative retinopathy is independently associated with decreased myocardial function assessed by Tissue Doppler Imaging in patients with Type 1 Diabetes Mellitus without history of heart disease.
Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaards vej 28, 2900 Hellerup, Denmark. Electronic address: nina_030890@hotmail.com.
Nina
N
Nouhravesh
Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark.
Henrik U
HU
Andersen
Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaards vej 28, 2900 Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
Jan S
JS
Jensen
Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Faculty of Health, University of Aarhus, Katrinebergvej 89F, 8200 Aarhus N, Denmark.
Peter
P
Rossing
Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaards vej 28, 2900 Hellerup, Denmark; Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Department of Internal Medicine, Holbaek Hospital, Smedelundsvej 60, 4300 Holbaek, Denmark.
Magnus T
MT
Jensen
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000209:etiology*; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
Diabetes; Echocardiography; Prevention; Retinopathy; Type 1 diabetes