Comprehensive echocardiographic and biomarker assessment of patients with diabetic ketoacidosis
Edgar Francisco Carrizales-Sepúlveda1,2, Alejandro Ordaz-Farías3,4, Raymundo Vera-Pineda3
1Cardiology Service, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico. edgar.carri_89@hotmail.com.
Insights
Diabetic ketoacidosis (DKA) causes temporary heart changes, often indicating a hyperdynamic state that resolves post-episode. Some patients experience myocardial injury and left ventricular dysfunction during DKA.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Diabetic ketoacidosis (DKA) involves systemic stress, inflammation, and metabolic derangements that can impact cardiovascular health.
- Previous studies suggest potential cardiac damage during DKA, necessitating further investigation into its structural and functional effects.
Purpose of the Study:
- To evaluate cardiac structure and function during and after diabetic ketoacidosis (DKA) episodes.
- To assess changes using echocardiography and cardiac biomarker analysis.
Main Methods:
- Transthoracic echocardiograms (TTE) were performed during DKA treatment and after resolution.
- Evaluated left ventricular (LV) dimensions, wall thickness, systolic/diastolic function (including LVEF and GLS), and cardiac troponin levels.
Main Results:
- LV isovolumetric contraction/ejection and relaxation times were significantly altered during DKA, normalizing post-resolution.
- LV volumes and diameters increased post-DKA resolution; LVEF and GLS showed no significant change between phases.
- Cardiac troponin elevation occurred in 20% of subjects, and LV dysfunction was observed in 35%.
Conclusions:
- DKA induces transient cardiac structural and functional changes, often reflecting a hyperdynamic state that resolves after DKA episode resolution.
- Some individuals exhibit myocardial injury (elevated troponin) and persistent left ventricular dysfunction post-DKA.
Background:
Systemic stress, inflammation, and hydroelectrolytic and acid‒base abnormalities observed during diabetic ketoacidosis (DKA) can cause changes in the heart and even induce cardiovascular damage. We aimed to evaluate the structure and function of the heart during and after a DKA episode via echocardiography and biomarker assessment.
Methods:
We performed a transthoracic echocardiogram (TTE) in subjects with an episode of DKA in the first 4-6 h of treatment. We evaluated left ventricular wall thickness, diameters and volumes, as well as systolic and diastolic function using tissue Doppler imaging, pulsed wave Doppler and left ventricular ejection fraction (LVEF). Left ventricular function was also assessed with global longitudinal strain (GLS). We obtained cardiac troponin levels in the first 24 h after admission. A second TTE was performed following the same protocol 6-12 h after the resolution of the DKA episode.
Results:
We included a total of 20 subjects. The mean age was 33 ± 13.6 years; 70% were female, and 70% had type 1 DM. 75% of the patients experienced severe episodes, and the rest experienced moderate episodes. Left ventricular isovolumetric contraction and ejection time were significantly shorter during DKA and prolonged after the resolution of the episodes (47.6 ± 9.9 vs. 62.2 ± 14.1, p = < 0.001) and (218.6 ± 37.9 vs. 265.06 ± 34.7). The isovolumetric relaxation time was also shorter during DKA, (41.72 ± 8.29 vs. 59.32 ± 17.98, p = < 0.001). Volumes and diameters of the left ventricle increased significantly after DKA resolution. We found no difference between LVEF or GLS during and after DKA resolution. 20% of the participants had troponin elevations, half of whom had moderate episodes and half of whom had severe episodes. 35% had LV dysfunction, 28.5% both in GLS and LVEF. 28.5% occurred after DKA resolution, with alterations in GLS.
Conclusions:
Diabetic ketoacidosis induces changes in the structure and function of the heart, which are mostly transient, reflect the presence of a hyperdynamic state and resolve after the resolution of the episode. Some subjects present with evidence of myocardial injury with elevated cardiac troponin and left ventricular dysfunction.
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