Investigation of brain natriuretic peptid on prediction of early myocardial dysfunction in type 1 diabetic children

Objective: To compare the tissue doppler imaging and echocardiography in theassesment of early myocardial dysfunction and in correlation with serum NT-proBNP levelsin Type 1 diabetic patients.Methods: The study group included 40 Type 1 diabetic children were admitted to thepediatric endocrinology policlinic of Düzce Unıversitiy Medical School Hospital. 40 healthychildren who had the similar age, sex and sociodemographic properties were selected for thecontrol group. In a clinical examination serum NT-proBNP levels were measured,echocardiography and tissue doppler imaging were performed in both groups. In addition tothe control group laboratory investigations also included the serum HbA1c level, tiroidfunction (TSH, Ft4) and urinary microalbumine levels in the study group.The statistical analysis was performed by Student?s t-test, Mann Whitney U test andSpearman?s correlation test. p<0,05 was considered statistically significant.Results: Median age and duration of diabetes in the study and control groups were11,4±2,6 and 3,6±2,5 years respectively. Median fasting blood glucose was 206,5 (108-312)mg/dl. In type 1 DM patients mean HbA1c level was 8,5±1,7% and higher levels of HbA1c of6% was defined as poor glycaemic controlled. While the lipid levels of control group wasnormal, mean total cholesterol levels were higher 159 (±37,25) mg/dl ın the study group.In control group; median NT-proBNP concentration was 63,1 pg/ml (±7,42)and in thediabetic group 79,8 pg/ml (±8,3).Echocardiographic assesment of both groups showed that Type 1 diabetic group hadminimal decrease in left ventricule systolic and enddiastolic diameter and controls had normaldimensions.In controls EF value was 66,0(±4,75)% and 65,0(±4,00)% in the Type 1 diabeticgroup. While left ventricule mass and mass index were calculated in both groups, there wasno statistically significant difference between groups.Doppler echocardiography was performed to evaluate the left ventricule (LV) diastolicfunction in both groups. LV septum, lateral, anterior, posterior, inferior wall parameters wasmeasured. Both groups had no signaficant diastolic dysfunction.In Type 1 diabetics group; there wasn?t a significant correlation between level of NTproBNPconcentration and duration of diabetes, value of HbA1c, lipid profile and leftventricule mass index.Conclusion: This study showed that left ventricule diastolic function were derangedand this might be a predictor of diabetic cardiomyopaty. Diastolic functions can be observednoninvasively by doppler echocardiography before the clinical syptoms and fundingsappeared in Type 1 diabetic children.Key words: Child, Type 1 diabetes mellitus, Echocardiography, Tissue Doppler, Diastolicdysfunction, Systolic dysfunction, NT- proBNP