Speckle Tracking Analysis of the Left and Right Heart in Type 1 Diabetes Patients with End-Stage Renal Disease Awaiting Simultaneous Pancreas–Kidney Transplantation

Q: What are the key findings of this study?

Type 1 diabetes patients with end-stage renal disease exhibited significantly reduced global longitudinal strain compared to healthy controls (10.69% vs 17.19%, p<0.001), indicating early subclinical myocardial dysfunction.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Type 1 diabetes with end-stage renal disease (n=84). Intervention: Type 1 diabetes with end-stage renal disease vs. End-stage renal disease without diabetes and healthy controls. Primary outcome: Global longitudinal strain (GLS) (β -5.68, 95% CI -7.48 to -3.88, p=<0.001).

Q: What does this research mean for the field?

Patients with type 1 diabetes and end-stage renal disease exhibit subclinical myocardial dysfunction characterized by significantly reduced global longitudinal strain compared to healthy controls (10.69% vs 17.19%, p<0.001), indicating an adverse effect of diabetes on cardiac mechanics independent of kidney disease. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether patients with type 1 diabetes and end-stage renal disease awaiting simultaneous pancreas–kidney transplantation exhibit echocardiographic evidence of cardiomyopathy, and whether these cardiac changes are attributable to diabetes rather than chronic kidney disease alone.

Kun Zhang; K. Haag; Ingo Hilgendorf; Fabian Halleck; Andreas Kahl; Lukas J. Lehner

doi:10.3390/diagnostics16193166

September 29, 2026DiagnosticsOpen Access

Speckle Tracking Analysis of the Left and Right Heart in Type 1 Diabetes Patients with End-Stage Renal Disease Awaiting Simultaneous Pancreas–Kidney Transplantation

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Key result

Type 1 diabetes with ESRD linked to ~6-point lower GLS vs healthy controls.

β -5.68
95% CI -7.48 to -3.88
P<0.001
n=84

Figures

Why the study?

Diabetic cardiomyopathy is an under-recognized complication in T1DM patients with ESRD, and its cardiac manifestations prior to SPKT are unclear.

Does type 1 diabetes contribute to subclinical myocardial dysfunction independently of chronic kidney disease in patients with end-stage renal disease?

Key Points

To determine whether patients with type 1 diabetes and end-stage renal disease awaiting simultaneous pancreas–kidney transplantation exhibit echocardiographic evidence of cardiomyopathy, and whether these cardiac changes are attributable to diabetes rather than chronic kidney disease alone.
Retrospectively analyzed preoperative 2D speckle-tracking echocardiograms from 16 patients with type 1 diabetes and end-stage renal disease awaiting simultaneous pancreas–kidney transplantation.
Compared cardiac structural and strain parameters against matched control cohorts: 20 non-diabetic patients with end-stage renal disease and 48 healthy controls.
Evaluated left and right heart deformation using mixed-effects linear regression models adjusted for age, sex, hypertension, and coronary artery disease.
Average left ventricular global longitudinal strain was markedly reduced in transplant candidates (10.69 ± 2.42%) versus healthy controls (17.19 ± 1.68%; p < 0.001) and independently associated with clinical group status (β = −5.68, CI: −7.48 to −3.88, p < 0.001).
Global circumferential strain was significantly lower in diabetic patients than in non-diabetic renal failure controls (p = 0.002) and healthy controls (p < 0.001), remaining independently associated with group status (β = −8.51, CI −14.22 to −2.80, p = 0.004).
Left ventricular mass and left atrial volumes were increased and left atrial strain was decreased in both diseased groups, whereas right ventricular strain parameters did not significantly differ across groups.

Study Design

Type

Observational (n=84)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does type 1 diabetes contribute to subclinical myocardial dysfunction independently of chronic kidney disease in patients with end-stage renal disease?

P

Population

84 participants with a mean age of 42 years, including 16 with type 1 diabetes and ESRD awaiting transplantation, 20 with ESRD only, and 48 healthy controls, evaluated for subclinical myocardial dysfunction.

E

Exposure

Type 1 diabetes mellitus combined with end-stage renal disease (ESRD) awaiting simultaneous pancreas-kidney transplantation (SPKT)

C

Comparator

Individually age- and sex-matched ESRD patients without diabetes (n=20) and healthy controls (n=48)

O

Outcome

Left and right ventricular/atrial function and structure, specifically 2D speckle-tracking strain (global longitudinal strain [GLS], global radial strain [GRS], and global circumferential strain [GCS])surrogate

Main Result

Mean Difference: -5.68 (95% CI -7.48–-3.88)

Absolute Event Rate: 10.69% vs 17.19%

p-value: p=<0.001

Limitations

Retrospective, single-center design and small sample size
Potential selection bias due to retrospective selection based on availability of adequate pre-transplant echocardiographic data
Echocardiograms were acquired by different operators, introducing potential variability
Lack of detailed information on dialysis timing relative to echocardiography, ultrafiltration volume, and volume status
Retrospective selection of patients based on availability of pre-transplant echocardiographic data may have introduced selection bias

Implication

Patients with type 1 diabetes and end-stage renal disease show greater impairment in subclinical left ventricular systolic function—particularly circumferential and radial strain—than matched non-diabetic patients with end-stage renal disease, indicating a distinct pathophysiological contribution of diabetes.

Abstract

Background/Objectives: Diabetic cardiomyopathy is an under-recognized complication of type 1 diabetes mellitus (T1DM), often co-existing with diabetic nephropathy. This study investigates whether patients with T1DM and end-stage renal disease (ESRD) undergoing simultaneous pancreas–kidney transplantation (SPKT) show echocardiographic signs of cardiomyopathy prior to surgery and explores whether cardiac changes are more attributable to diabetes itself or to chronic kidney disease. Methods: We retrospectively analyzed preoperative echocardiographic data of 16 SPKT patients with T1DM and ESRD, using 2D speckle tracking for strain assessment. Data were compared to individually matched control groups: (1) ESRD patients without diabetes (n = 20) and (2) healthy controls (n = 48). Left and right ventricular/atrial function and structure were analyzed, including 2D speckle-tracking analysis. A mixed-effects model adjusted for age, sex, coronary artery disease, and hypertension. Results: SPKT patients exhibited significant structural changes in the left heart, including increased left ventricular mass and left atrial volume index, alongside reduced global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) compared to healthy controls. GRS and GCS were significantly lower in the SPKT group than in the ESRD group without diabetes. Left atrial strain and strain rates were reduced in both disease groups. Right ventricular and atrial strain parameters did not significantly differ between groups. Mixed model analysis confirmed significant strain differences in the left ventricle even after adjusting for confounders. Conclusions: T1DM patients with end-stage nephropathy awaiting SPKT show echocardiographic abnormalities compatible with subclinical myocardial dysfunction, with predominant involvement of the left heart. Compared to non-diabetic ESRD patients, the diabetic cohort exhibited greater impairment in left ventricular strain parameters, supporting a pathophysiologic role of diabetes independent of kidney disease. Speckle-tracking analysis demonstrated potential utility for detecting early signs of myocardial dysfunction in this high-risk population.

Discussion

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Cite This Study

Zhang et al. (2026) conducted an observational in Type 1 diabetes with end-stage renal disease (n=84). Type 1 diabetes with end-stage renal disease vs. End-stage renal disease without diabetes and healthy controls was evaluated on Global longitudinal strain (GLS) (β -5.68, 95% CI -7.48 to -3.88, p=<0.001). Type 1 diabetes patients with end-stage renal disease exhibited significantly reduced global longitudinal strain compared to healthy controls (10.69% vs 17.19%, p<0.001), indicating early subclinical myocardial dysfunction.

synapsesocial.com/papers/6ad0fd3315427f6a840405ed https://doi.org/10.3390/diagnostics16193166

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Speckle Tracking Analysis of the Left and Right Heart in Type 1 Diabetes Patients with End-Stage Renal Disease Awaiting Simultaneous Pancreas–Kidney Transplantation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Speckle Tracking Analysis of the Left and Right Heart in Type 1 Diabetes Patients with End-Stage Renal Disease Awaiting Simultaneous Pancreas–Kidney Transplantation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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