Prevalence,predictors and evolution of echocardiographically defined cardiac abnormalities in adults with type 1 diabetes: an observational cohort study |
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| Institution: | 1. Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia;2. Department of Cardiology, Austin Health, Melbourne, Australia;3. Department of Endocrinology & Diabetes, St Vincent’s Hospital & University of Melbourne, Melbourne, Australia;4. Endocrine Centre of Excellence, Austin Health, Melbourne, Australia;1. Steno Diabetes Center, Gentofte, Denmark;2. Department of Biomedical Sciences, University of Copenhagen;3. Center for Healthy Ageing, University of Copenhagen;4. Molecular Physiology Group, The August Krogh Centre, Department of Nutrition, Exercise and Sports, University of Copenhagen;5. Rigshospitalet, Department of Endocrinology, Denmark;1. Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA;2. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA;3. Charles Drew University of Medicine and Science, Research Life Sciences Institute, Los Angeles, CA;4. David Geffen School of Medicine, Los Angeles, CA;1. Department of Internal Medicine – Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA;2. Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA;3. Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA;4. Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA;5. Division of Public Health Sciences - Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA;1. Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK;2. Barts and The London SMD, London, UK;3. Vitamin D Research Group, School of Biomedicine, University of Manchester, UK;4. Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, UK;5. Department of Diabetes and Nutritional Sciences, King''s College and St Thomas'' and Guy''s Hospitals, UK |
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| Abstract: | Aims/hypothesisThe aims of this observational study were to determine the prevalence and predictors of an abnormal echocardiogram in adults with type 1 diabetes, and to assess the evolution of changes in a subset of subjects.MethodsCardiac function and structure were prospectively investigated by comprehensive transthoracic echocardiographic techniques in asymptomatic adults with type 1 diabetes seen in the ambulatory care setting.ResultsWe recruited 136 subjects (mean age 39 years, SD 14 years) with a median diabetes duration of 21 years 25th, 75th interquartile range; 11, 29]. An abnormal echocardiogram was present in 29% of subjects; diastolic dysfunction in 69%, left ventricular hypertrophy in 38% and systolic dysfunction in 10%. The independent predictors of an abnormal echocardiogram were age, with a 9-fold increase in those ≥ 40 years (OR 9.40 95% CI 2.68–33.04], P < 0.0001), and increased body mass index (BMI), with a 17% increase in risk (P = 0.04). A second echocardiogram was available in 65 subjects (3.8 ± 1.7 years later). The results showed that one in five with a normal first study had developed an abnormal second study, mainly diastolic dysfunction, with age being the only independent predictor of progression (P = 0.006).Conclusions/interpretationSubclinical echocardiographic abnormalities are common in asymptomatic type 1 diabetes adults, and changes are progressive. The addition of an echocardiogram to complication surveillance programs in those with type 1 diabetes aged ≥ 40 years may represent a cost-effective way to screen for, and aggressively treat, occult cardiac disease. |
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