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Incipient cardiomyopathy in young insulin-dependent diabetic patients: a seven-year prospective Doppler
O Gøtzsche1, A Darwish, L Gøtzsche
1University Department of Cardiology, Aarhus Amtssygehus, Denmark.
Insights
Diabetic children showed reduced left ventricular size and altered heart function over seven years, suggesting a potential metabolic cardiomyopathy. These early cardiac changes occur even without hypertension or kidney disease.
Area of Science:
- Cardiology
- Pediatrics
- Metabolic Disorders
Background:
- Insulin-dependent diabetes mellitus (IDDM) can lead to cardiovascular complications.
- Early detection of cardiac abnormalities in diabetic children is crucial for timely intervention.
- This study investigates cardiac changes in diabetic children without established complications like hypertension or nephropathy.
Purpose of the Study:
- To detect early signs of cardiac abnormalities in insulin-dependent diabetic children.
- To assess changes in cardiac structure and function over a 7-year period.
- To explore potential links between cardiac changes, autonomic neuropathy, and aortic stiffening.
Main Methods:
- Two echo-Doppler cardiographic investigations performed 7 years apart.
- 17 insulin-dependent diabetic children without hypertension or nephropathy.
- Comparison with two matched control groups.
Main Results:
- Diabetic children exhibited a reduced increase in left ventricular size and stroke volume compared to controls.
- Initially reduced end-systolic wall stress and increased fractional shortening normalized over 7 years.
- Left ventricular filling showed changes, including increased velocity during atrial contraction, correlating with decreased stroke volumes.
Conclusions:
- Early cardiac changes, including reduced left ventricular cavity size and altered atrial ejection, suggest a metabolically-induced cardiomyopathy in diabetic children.
- These findings may indicate left ventricular restriction or a shift in autonomic balance.
- The study highlights the importance of monitoring cardiac health in diabetic children from an early stage.
Abstract:
Two echo-Doppler cardiographic investigations were performed 7 years apart in 17 insulin-dependent diabetic children without hypertension or nephropathy in order to detect early signs of cardiac abnormalities in this group without ischaemic heart disease. Relative to two matched control groups, the patients had reduced increase in left ventricular size (p < 0.01) and stroke volume (p < 0.05). An initially reduced end systolic wall stress and increased fractional shortening (p < 0.003) was normalized during the 7 years. Concomitant with early signs of autonomic neuropathy and aortic stiffening, left ventricular filling changed with increased velocity during atrial contraction (p < 0.01) correlating to the decreased stroke volumes (r = -0.57, p = 0.016). These early changes could suggest left ventricular restriction but could also reflect a changed sympathetic/parasympathetic balance in diabetic children. A reduced left ventricular cavity size and increased atrial ejection has thus been described in these insulin-dependent children without hypertension, nephropathy or evidence for ischaemic heart disease, suggesting the existence of a metabolically-induced cardiomyopathy.