Retinopathy is associated with impaired myocardial function assessed by advanced echocardiography in type 1 diabetes patients - The Thousand & 1 Study

Aims: Retinopathy and heart disease in Type 1 Diabetes Mellitus (Type 1 DM) may be associated; however previous results have been conflicting. Tissue Doppler Imaging (TDI) and speckle-tracking echocardiography (STE) quantify myocardial function not assessable by conventional echocardiography. We investigated the association between severity of retinopathy and early myocardial dysfunction using conventional echocardiography, TDI and STE in Type 1 DM patients. Methods: Type 1 Diabetes Mellitus patients without known heart disease were included from the Steno Diabetes Center. The cross sectional association between retinopathy and myocardial function was analyzed in uni- and multivariable models. Retinopathy was categorized as nil-, simplex-or proliferative retinopathy. Results: A total of 1090 Type 1 Diabetes Mellitus patients were included, mean age was 49.6 years and 53% were males. Left ventricular ejection fraction did not differ between groups of retinopathy. Global longitudinal strain (GLS) by STE decreased significantly with increasing degrees of retinopathy (nil; -18.6%, simplex; -18.2% (p = 0.024), proliferative; -17.7% (p < 0.001)), however differences attenuated in multivariable models (p >= 0.05). In univariable models, myocardial tissue velocities differed in relation to retinopathy: s' (nil; 6.9, simplex; 6.5, proliferative; 5.9 (p = 0.001), e' (nil; 10.4, simplex; 9.2, proliferative; 7.9, p < 0.001), a' (nil; 6.1, simplex; 6.7, proliferative; 7.0, p < 0.001) and E/e' (nil; 6.7, simplex; 7.5, proliferative; 9.5, p < 0.001). In multivariable models, differences persisted between nil and proliferative retinopathy for s', e' and E/e'. Conclusion: Proliferative retinopathy is independently associated with decreased myocardial function assessed by Tissue Doppler Imaging in patients with Type 1 Diabetes Mellitus without history of heart disease. (c) 2016 Elsevier Ireland Ltd. All rights reserved.