Right Ventricular Deformation in Asymptomatic Children with Type I Diabetes Mellitus

Background: Right ventricular function in diabetic children was not fully addressed. Previous reports were mainly directed for the left ventricle. Our objective was to investigate the subclinical effects of diabetes on right ventricular systolic and diastolic function in asymptomatic children with type 1 D.M. using echocardiographic two dimensional strain and strain rate. Methods: This study was conducted on 45 children with type 1 DM and 20 apparently normal children with comparable age, sex and socioeconomic status as a control group. Each patient was subjected to history taking, physical examination, routine laboratory investigations and conventional echocardiographic examination. Apical four chamber view was used for offline analysis of RV deformation data including assessment of systolic strain (ε), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe) and Peak late diastolic strain rate (SRa) obtained from the basal, mid and apical segments of the RV free wall. Results: Although conventional echocardiography failed to reveal any impairment in RV systolic performance (measured with Tricuspid Annular Plane Systolic Exercursion, TAPSE), the values of systolic strain and peak systolic strain rate in the basal, mid and apical segment of the RV free wall were significantly lower in DM group as compared with control group indicating impairment of RV systolic function. Similarly, decreased peak early diastolic strain rate in children with diabetes in RV free wall reflecting abnormalities of RV diastolic performance. Conclusion: Diabetes mellitus type 1 leads to RV systolic and diastolic dysfunction. Strain and strain rate imaging appear to be a sensitive tool for early detection such abnormalities.