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Left ventricular longitudinal systolic dysfunction in children with type 1 diabetes mellitus: A systematic review and

Alpa Gupta1, Prajith Jeyaprakash1, Seyed-Mohammad Ghoreyshi-Hefzabad2

  • 1Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, NSW, Australia; Department of Cardiology, Nepean Hospital, NSW, Australia.

Journal of Diabetes and Its Complications
|July 17, 2023
PubMed

Insights

Children with type 1 diabetes mellitus (T1DM) show early signs of subclinical heart dysfunction, specifically in left ventricular longitudinal strain, even with preserved ejection fraction. This indicates a need for monitoring cardiac function in pediatric T1DM patients.

Area of Science:

  • Cardiology
  • Pediatrics
  • Endocrinology

Background:

  • Type 1 diabetes mellitus (T1DM) in children can lead to subclinical myocardial insults, but findings vary.
  • Assessing left ventricular (LV) myocardial strain is crucial for early detection of cardiac dysfunction in pediatric T1DM patients without overt heart disease.

Approach:

  • A systematic review and meta-analysis was conducted using data from five databases up to March 30, 2020.
  • Included studies utilized two-dimensional speckle tracking echocardiography to compare LV global longitudinal strain (LVGLS) and LV global circumferential strain (LVGCS) in asymptomatic pediatric T1DM patients and healthy controls.

Key Points:

  • The meta-analysis included 10 studies for LVGLS (755 T1DM patients, 610 controls) and 6 studies for LVGCS (534 T1DM patients, 403 controls).
  • Pediatric T1DM patients exhibited significantly lower LVGLS (MD = -3.01%) compared to healthy controls.
  • While LVGCS was also reduced in T1DM patients, the difference was not statistically significant (MD = -3.10%).
  • Higher levels of Hemoglobin A1c (HbA1c) were correlated with worse LVGLS.

Conclusions:

  • Subclinical left ventricular systolic dysfunction is present in children with T1DM, even when ejection fraction is preserved.
  • Longitudinal cardiac function is altered in pediatric T1DM, whereas circumferential function remains largely unaffected.
  • Global Longitudinal Strain (GLS) serves as a valuable metric for detecting subclinical LV systolic dysfunction in the pediatric population with T1DM.
Abstract

Keywords:
2D-speckle tracking echocardiographyDiabetic cardiomyopathyMean differenceMeta-analysisMyocardial strainType 1 diabetes mellitus

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