Investigation of cardiac functions and aortic stiffness in children with type 1 diabetes mellitus: A prospective study

Ajda Mutlu Mihcioglu; Eda Celebi Bitkin

doi:10.5281/zenodo.8371161

Authors

Ajda Mutlu Mihcioglu University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Istanbul, Turkey https://orcid.org/0000-0003-0143-4188
Eda Celebi Bitkin Unıversity of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey https://orcid.org/0000-0002-6586-7305

DOI:

https://doi.org/10.5281/zenodo.8371161

Keywords:

Aortic stiffness, Children, Diastolic function, Type 1 diabetes

Abstract

Objective: Cardiovascular diseases represent the most serious complications in the patients with type 1 diabetes mellitus (DM). Endothelial dysfunction and increased aortic stiffness play role in the occurance of these disorders. Aim of this study is to evaluate the patients cardiac functions and aortic elasticity parameters in children with type 1 DM.

Materials and methods: Thirty nine patients with type 1 DM and 39 controls were included in the study. After physical examination, cardiac evaluation was performed with conventional echocardiography, Doppler and tissue Doppler echocardiography. Aortic elasticty parameters were calculated.

Results: Systolic blood pressure, mean arterial pressure (MAP), pulse pressure (PP) and heart rate (HR) were higher in the patients than controls (p<0.05, for all). Mitral E wave velocity, E/A, E’/A’ lateral were decreased, while E wave deceleration time, A’lateral, myocardial performance index (MPI) lateral and septal were increased in the patient group than controls (p>0.05, for all). Aortic systolic and diastolic diameters and aortic elasticity parameters were similar with controls (p>0.05, for all). Echocardiographic parameters and aortic elasticity parameters were similar in the patients who were grouped according to hemoglobin A1c and duration of diabetes (p>0.05, for all). E wave velocity was positively related with PP, while E’/A’ was positively associated with HR and negatively associated with MAP and diastolic blood pressure (p<0.05, for all).

Conclusions: Diastolic dysfunction findings were stated in the diabetic children. Even though aortic compliance did not show impairment, periodic cardiac evaluation should be performed in case of progression. Patients with type 1 diabetes should be monitored for endothelial dysfunction and aortic stiffness when the prolonged life expectancy was take into account for diabetic children.

References

Abd-El Aziz FM , Abdelghaffar S , Hussien EM, Fattouh AM. Evaluation of Cardiac Functions in Children and Adolescents with Type 1 Diabetes J Cardiovasc Ultrasound. 2017;25(1):12-9.

Çiftel M, Ertug H, Parlak M, Akçurin G, Kardelen F. Investigation of endothelial dysfunction and arterial stiffness in children with type 1 diabetes mellitus and the association with diastolic dysfunction. Diabetes & Vascular Disease Research 2014;11(1):19-25.

Llauradó G , Ceperuelo-Mallafré V, Vilardell C, Simó R, Freixenet N, Vendrell J, et al. Arterial stiffness is increased in patients with type 1 diabetes without cardiovascular disease: a potential role of low-grade inflammation. Diabetes Care. 2012;35(5):1083-9.

Shah AS, Wadwa RP, Dabelea D, Hamman RF, D'Agostino Jr R, Marcovina S, et al. Arterial stiffness in adolescents and young adults with and without type 1 diabetes: the SEARCH CVD study Pediatr Diabetes. 2015;16(5):367-74.

Deveci MF, Akkurt V, Keskın M, Başpınar O. Tip 1 Diyabetli Çocuklarda Aort Elastikiyetinin Değerlendirilmesi. Forbes J Med 2022;3(3):273-8.

Kim EH, Kim YH. Left ventricular function in children and adolescents with type 1 diabetes mellitus Korean Circ J. 2010;40(3):125-30.

Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19(12):1413-30.

Brunvard L , Heier M, Brunborg C, Hanssen KF, Fugelseth D, Stensaeth KH, et al. Advanced glycation end products in children with type 1 diabetes and early reduced diastolic heart function. BMC Cardiovasc Disord. 2017;17(1):133.

Nemes A, Geleijnse ML, Forster T, Soliman OI, Ten Cate FJ, Csanády M. Echocardiographic evaluation and clinical implications of aortic stiffness and coronary flow reserve and their relation. Clin Cardiol. 2008;31(7):304-9.

Jurko A Jr, Jurko A, Minarik M. Doppler-derived myocardial performance index in healthy children. Bratisl Lek Listy. 2011;112(2):77-9.

Suys BE , Katier N, Rooman RPA, Matthys D, Beeck LOD, Caju MVLD, et al . Female children and adolescents with type 1 diabetes have more pronounced early echocardiographic signs of diabetic cardiomyopathy Diabetes Care. 2004;27(8):1947-53.

Dragulescu A , Mertens L, Friedberg MK. Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations Circ Cardiovasc Imaging. 2013;6(2):254-61.

Trost SU, Belke DD, Bluhm WF, Meyer M, Swanson E, Dillmann WH. Overexpression of the sarcoplasmic reticulum Ca2+- ATPase improves myocardial contractility in diabetic cardiomyopathy. Diabetes. 2002;51(4):1166-71.

Aepfelbacher FC, Yeon SB, Weinrauch LA, D’Elia J, Burger AJ. Improved glycemic control induces regression of left ventricular mass in patients with type 1 diabetes mellitus. Int J Cardiol. 2004;94(1):47-51.

Nagueh S, Middleton K, Kopelen H, Zoghbi WA, Quinones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30(6):1527-33.

Ommen SR, Nishimura RA, Appleton MD, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comperative simultaneous Doppler catheterization study. Circulation. 2000;102(15):1788-94.

Wan SH, Vogel MW, Chen HH. Pre-clinical diastolic dysfunction. J Am Coll Cardiol. 2014;63(5):407-16.

Di Cori AD, Di Bello V, Miccoli R, Talini E, Palagi C, Donne MGD, et al. Left ventricular function in normotensive young adults with well-controlled type 1 diabetes mellitus. Am J Cardiol. 2007;99(1):84-90.

de Simone G, Mureddu GF, Vaccaro O, Greco R, Sacco M, Rivellese A,et al. Cardiac abnormalities in type 1 diabetes. Ital Heart J. 2000;1(7):493-9.

Romanens M, Fankhauser S, Saner B, Michaud L, Saner H. No evidence for systolic or diastolic left ventricular dysfunction at rest in selected patients with long-term type I diabetes mellitus. Eur J Heart Fail. 1999;1(2):169-75.

Bradley TJ, Slorach C, Mahmud FH , Dunger DB , Deanfield J , Deda L, et al. Early changes in cardiovascular structure and function in adolescents with type 1 diabetes. Cardiovasc Diabetol. 2016;15:31.

Brunvand L, Fugelseth D, Stensaeth KH, Dahl-Jørgensen K, Margeirsdottir HD. Early reduced myocardial diastolic function in children and adolescents with type 1 diabetes mellitus a population-based study. BMC Cardiovasc Disord. 2016;16:103.

Turkbey EB , Redheuil A, Backlund JYC, Small AC, Cleary PA, Lachin JM, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Aortic distensibility in type 1 diabetes. Diabetes Care. 2013;36(8):2380-7.

González-Clemente JM, Cano A, Albert L, Giménez-Palop O, Romero A, Berlanga E, et al. Arterial Stiffness in Type 1 Diabetes: The Case for the Arterial Wall Itself as a Target Organ. J Clin Med. 2021;10(16):3616.

Bjarnegård N, Arnqvist HJ, Lindström T, Jonasson L, Jönsson A, Länne T. Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus. Diab Vasc Dis Res. 2009;6(1):25-31.

Holzmann M, Olsson A, Johansson J, Jensen-Urstad M. Left ventricular diastolic function is related to glucose in a middle-aged population. J Intern Med. 2002;251(5):415–420.

Adal E, Koyuncu G, Aydin A, Celebi A, Kavunoğlu G, Cam H. Asymptomatic cardiomyopathy in children and adolescents with type 1 diabetes mellitus: association of echocardiographic indicators with duration of diabetes mellitus and metabolic parameters. J Pediatr Endocrinol Metab. 2006;19(5):713-26.

From AM, Scott CG, Chen HH. Changes in diastolic dysfunction in diabetes mellitus over time. Am J Cardiol. 2009;103(10):1463-6.