Early myocardial impairment in type 1 diabetes patients without known heart disease assessed with tissue Doppler echocardiography: The Thousand & 1 study

Abstract

Purpose: Cardiovascular disease is the most common cause of mortality in type 1 diabetes; patients with albuminuria are at greatest risk. We investigated myocardial function and premature myocardial impairment in type 1 diabetes patients with and without albuminuria compared to controls. Methods: This study included a cross-sectional survey of 1093 type 1 diabetes patients from Steno Diabetes Center and 200 healthy controls. Conventional and tissue Doppler echocardiographic measurements were analysed in multivariable models in normoalbuminuria (n = 760), microalbuminuria (n = 227) and macroalbuminuria (n = 106). Investigators were blinded to degree of albuminuria. Results: For the type 1 diabetes patients, mean age was 49.6 years, 53% were men and mean diabetes duration was 25.5 years. In multivariable models systolic velocity s′ did not differ between type 1 diabetes patients with normoalbuminuria and controls (β-coefficient [95% confidence interval]: â'0.17 [â'0.41; 0.08], p = 0.19), but was impaired between controls and microalbuminuria (â'0.53 [â'0.84; â'0.23], p = 0.001) and macroalbuminuria (â'0.59 [â'0.96; â'0.22], p = 0.002). Diastolic measurements (e′, a′, e′/a′, and E/e′) were all significantly impaired in type 1 diabetes, for example, e′/a′: normoalbuminuria, microalbuminuria and macroalbuminuria versus controls: â'0.38 [â'0.52; â'0.23], p < 0.001; â'0.49 [â'0.67; â'0.32], p < 0.001; and â'0.81 [â'1.03; â'0.59], p < 0.001. In age-related analyses, myocardial impairment occurred prematurely in type 1 diabetes compared to controls (e.g. E/e′ = 8; 9.2 years [normoalbuminuria], 17.3 years [microalbuminuria] and 41.4 years [macroalbuminuria] prematurely, respectively). Conclusion: In type 1 diabetes patients with albuminuria, both systolic and diastolic functions are impaired, whereas in patients without albuminuria only diastolic function is affected. Myocardial impairment is detectable many years prematurely in type 1 diabetes, especially in patients with albuminuria.