Atrial and ventricular dysfunction evaluation, with speckle-tracking imaging in type 1 diabetes mellitus and the relation ship with p dispersion, nt-probnp (n-terminal-probrain natriuretic peptide) levels

Type 1 Diabetes Mellitus is a systemic disease charecterized by hyperglycemia, resulting from inadequate insulin secretion and/or insufficient effect. It is the most common endocrine metabolic disease group in childhood and adolescence. The cardiovascular system diseases are the most common cause of morbidity and mortality in Type 1 Diabetes Mellitus patients. Aim of this study is the evaluation of cardiac dysfunction with Speckle-tracking echocardiography, P wave dispersion and measurement of NT-Pro-BNP levels in pediatric patients with Type 1 Diabetes Mellitus who did not yet develop micro and macro vascular complications, at least 3 years at last 10 years followed up and evaluation of relationship between this and disease duration, hyperglycemia control. 63 patients with Type 1 Diabetes Mellitus in pediatric endocrinology outpatient clinic were accepted to our study. Patients were divided into 2 groups according to the duration of follow up [Over 5 years old, 3-5 years follow up with Type 1 DM (Group 1), 6-10 years follow up with type 1 DM (Group 2)]. The control consisted of 36 subjects who were routinely referred for echocardiographic evaluation of an asymptomatic, innocent heart murmur and found to have no structural heart disease or acute/chronic illness. The control group is compatible with the patient group in age, gender, BMI. Conventional transthoracic echocardiography, left ventricular and left atrial speckle tracking echocardiography were performed in all patients. 12 lead electrocardiogram was recorded and blood was taken for evaluating NT-ProBNP. There were no statistical significant difference in systolic function with conventional echocardiographic examinations in patient and control groups. Mitral valve A wave velocity was higher than control group (0,59±0,16 /0,57±0,12 / 0,50±0,11), E/A wave ratio is lower in Group 1 and Group 2 patient group than control group (1,77±0,42 / 1,76±0,31 / 2,11±0,34). Left atrial diameter did not differ significantly between the groups. In strain echocardiographic evaluation; Atrial peak S (39,91±9,08 / 45,88±8,85), Strain A; (13,43±4,68 /15,82±5,02), Strain E;(26,86±7,54 / 29,77±7,65) in patient and control group, respectively. Peak S and Strain A values were statistically significantly lower in patient group. Left ventricular global longitudinal strain (-17,28±2,24 / -19,49±2,22), global radial strain (36,74±16,75 / 42,86±13,31), global circumferential strain (-12,86±3,19 / 17,71±4,62) values were lover in patient groups. P maximum and P dispersion values were higher in the patient group. NT-ProBNP levels did not differ significantly in the patient group 1 and group 2. There were no significant difference in HbA1c levels between the two patient groups which differs with the duration of follow up. Positive correlation between HbA1c levels and P max, P dis, A wave velocity and negative correlation between Strain E and E/A was found. There was no correlation between the duration of the follow up and ventricular strain parameters. As a result, conventional echocardiography may be insufficient on showing cardiac dysfunction in early stage in Type 1 DM patients. We found deterioration in left ventricular systolic functions and atrial functions with speckle tracking echocardiography methods in Type 1 DM patients while the conventional echocardiographic examinations were in normal range Also these patients showed increased left atrial heterogenity in the early stages of diabetes. Early detection of effects on target organs may prevent the irreversible damage and taking preventive measures are important in terms of improving the quality of life