Early reduced myocardial diastolic function in children and adolescents with type 1 diabetes mellitus a population-based study.
Early reduced myocardial diastolic function in children and adolescents with type 1 diabetes mellitus a population-based study.
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DOI：
10.1186/s12872-016-0288-1
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发表时间：
2016-05-25
影响因子：
2.1
通讯作者：
Margeirsdottir HD
中科院分区：
文献类型：
--
作者：
Brunvand L;Fugelseth D;Stensaeth KH;Dahl-Jørgensen K;Margeirsdottir HD
舒张期心肌功能降低是糖尿病心肌病的早期征兆。本研究的目的是验证一种假设，即没有其他已知并发症的1型糖尿病(T1D)儿童和青少年，在超声心动图彩色组织多普勒成像(CTDi)诊断的早期舒张期心肌功能下降。对173例T1D患者和62例年龄匹配的对照组进行CTDi检测。T1D患者年龄8~18岁，糖尿病病程平均5.6年(3.4年)，糖化血红蛋白平均8.4年(1.3%)。所有患者均接受胰岛素泵治疗或每天4-6次胰岛素注射。测量二尖瓣环、二尖瓣环、二尖瓣环。在所有患者中，A‘峰速度较高、E’/A‘比值较低的T1D患者的心肌舒张期功能均下降。二尖瓣E‘/A’比值在T1D组为2.3(0.5)，对照组为2.7(0.6)(p <； 0.0 1)。二尖瓣E‘/A’比值与血压(BP)和体重指数(BMI)呈负相关。根据BMI将所有参与者分为三组(分别为25、25-75和75百分位数)，除最高BMI组外，T1D在所有分层组中的E‘/A’值都较低，其中T1D和对照组的E‘/A’值都最低。收缩功能在任何测量中都没有不同。与性别、糖尿病病程、颈动脉内膜中层厚度、血管弹性或糖化血红蛋白无关。使用现代强化胰岛素治疗的糖尿病儿童和青少年，尽管病程较短，但超声心动图显示舒张期心肌功能降低。功能降低与更高的血压和更高的BMI相关。
Reduced diastolic myocardial function is an early sign of diabetic cardiomyopathy. The aim of this study was to test the hypothesis that children and adolescents with type 1 diabetes mellitus (T1D), but without other known complications, have early reduced diastolic myocardial function diagnosed with echocardiographic color tissue Doppler imaging (cTDI). cTDI examination was carried out in 173 T1D patients and 62 age-matched controls. The T1D-patients were 8–18 years old with (mean (SD)) diabetes duration of 5.6 (3.4) years and HbA1c of 8.4 (1.3). All were treated with either insulin pumps or 4–6 daily insulin injections. cTDI early (E’) and late (A’) peak diastolic velocities and systolic peak velocity were measured from the lateral, septal, anterior and posterior mitral annulus and from the lateral tricuspidal annulus. Myocardial diastolic function was reduced in the T1D-patients with higher peak A’-velocity and lower E’/A’-ratio in all registrations. Overall mean (SD) mitral E’/A’-ratio was 2.3 (0.5) in T1D and 2.7 (0.6) in the controls (p < 0001). The overall mitral E’/A’-ratio was negative associated with blood pressure (BP) and body mass index (BMI). Stratifying all participants into three groups according to BMI (<25, 25–75, >75 centile, respectively), the T1D had lower E’/A’-values in all stratified groups, except for in the highest BMI-group where both T1D and controls had the lowest E’/A’-ratio. Systolic function did not differ in any of the measurements. There were no associations with sex, diabetes duration, carotid artery intima-media-thickness, vessel elasticity or HbA1c. Diabetic children and adolescents using modern intensive insulin treatment had echocardiographic signs of reduced diastolic myocardial function despite short duration of disease. The reduced function was associated with higher BP and higher BMI.