Early changes in cardiovascular structure and function in adolescents with type 1 diabetes

Background: Children with type 1 diabetes (T1D) are at higher risk of early adult-onset cardiovascular disease. We assessed cardiovascular structure and function in adolescents with T1D compared with healthy controls and the relationships between peripheral vascular function and myocardial parameters. Methods and results: 199 T1D [14.4 +/- 1.6 years, diabetes duration 6.2 (2.0-12.8) years] and 178 controls (14.4 +/- 2.1 years) completed endothelial function by flow mediated vasodilatation (FMD), arterial stiffness using pulse wave velocity (PWV) along with M-mode, pulse wave and tissue Doppler, and myocardial deformation echo-cardiographic imaging. Systolic (113 +/- 10 vs. 110 +/- 9 mmHg; p = 0.0005) and diastolic (62 +/- 7 vs. 58 +/- 7 mmHg; p < 0.0001) blood pressures, carotid femoral PWV and endothelial dysfunction measurements were increased in T1D compared with controls. Systolic and diastolic left ventricular dimensions and function by M-mode and pulse wave Doppler assessment were not significantly different. Mitral valve lateral e' (17.6 +/- 2.6 vs. 18.6 +/- 2.6 cm/s; p < 0.001) and a' (5.4 +/- 1.1 vs. 5.9 +/- 1.1 cm/s; p < 0.001) myocardial velocities were decreased and E/e' (7.3 +/- 1.2 vs. 6.7 +/- 1.3; p = 0.0003) increased in T1D. Left ventricular mid circumferential strain (-20.4 +/- 2.3 vs. -19.5 +/- 1.7 %; p < 0.001) was higher, whereas global longitudinal strain was lower (-19.0 +/- 1.9 vs. -19.8 +/- 1.5 % p < 0.001) in T1D. Conclusions: Adolescents with T1D exhibit early changes in blood pressure, peripheral vascular function and left ventricular myocardial deformation indices with a shift from longitudinal to circumferential shortening. Longitudinal follow-up of these changes in ongoing prospective trials may allow detection of those most at risk for cardiovascular abnormalities including hypertension that could preferentially benefit from early therapeutic interventions.