Assessment of Subclinical Left Ventricular Systolic and Diastolic Dysfunction in Patients with Type 1 DM with and without Good Metabolic Control

Background: Diabetic patients with normal left ventricular ejection fraction (LVEF)are frequently associated with diastolic dysfunction. However, LVEF is known not to be a sensitive marker for the detection of subclinical LV systolic dysfunction. This study aimed to assess left ventricular systolic and diastolic function in asymptomatic type 1 diabetic patients by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to assess subclinical left ventricular systolic and diastolic dysfunction.

Methods: Case-control study was conducted at 150 patients aged 15-35 y were subdivided into three equal groups: Group A: with type 1 diabetes mellitus (T1DM) with good metabolic control (Hb A1C <7.0), Group B: T1DM with poor metabolic control (Hb A1C>7.0), and Group C: Control group: included 50 normal healthy subjects.

Results: Tissue Doppler, diastolic function and strain parameters, AP4C LS, AP2C LS, AP3C LS, and GLS were significantly impaired among the three groups. AP4C LS, AP2C LS, AP3C LS, and GLS were significantly lower in group B than group A and group C and was significantly lower in group A than group C, A velocity was significantly impaired among the three groups. A velocity was significantly higher in group B than group A and group C and was insignificantly impaired in group A than group C.

Conclusion: Conventional echocardiography parameters were insignificantly different between the study groups. 2D speckle tracking and tissue Doppler echocardiography showed that subclinical left ventricular systolic function may be affected even before affection of diastolic function. Longer duration and poor glycemic control of diabetes significantly affect GLS.