Key result
Type 1 diabetes mellitus was associated with subclinical biventricular diastolic and systolic dysfunction, evidenced by significantly reduced mean mitral septal E' velocity (8.89 vs 11.50 cm/s, p<0.001) compared to healthy controls.
Why the study?
Does tissue Doppler imaging detect subclinical systolic and diastolic dysfunction of both ventricles in normotensive patients with type 1 diabetes mellitus compared to healthy controls?
Cross-Sectional (n=101)
No
Does tissue Doppler imaging detect subclinical systolic and diastolic dysfunction of both ventricles in normotensive patients with type 1 diabetes mellitus compared to healthy controls?
Tissue Doppler imaging, particularly myocardial acceleration during isovolumetric contraction (IVA), is a sensitive technique for detecting early, subclinical systolic and diastolic dysfunction of both ventricles in patients with type 1 diabetes.
Answers are grounded in this paper and cite their sources.
TDI may detect subclinical biventricular dysfunction in T1DM; leaves open whether routine use improves outcomes or risk stratification.
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.
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Šuran et al. (2016) conducted a cross-sectional in Type 1 diabetes mellitus (n=101). Type 1 diabetes mellitus vs. Healthy controls was evaluated on Mean mitral septal early diastolic velocity (E'sept) (p=<0.001). Type 1 diabetes mellitus was associated with subclinical biventricular diastolic and systolic dysfunction, evidenced by significantly reduced mean mitral septal E' velocity (8.89 vs 11.50 cm/s, p<0.001) compared to healthy controls.
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