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Left ventricular systolic dysfunction in asymptomatic patients with diabetes mellitus type 1 is associated with duration of disease, obesity and poor glycemic control

Session Poster Session 3

Speaker Chris Kapelios

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : C Kapelios (Athens,GR), S Liatis (Athens,GR), M Bonou (Athens,GR), A Tentolouris (Athens,GR), A Barmpagianni (Athens,GR), M Driva (Athens,GR), I Eleftheriadou (Athens,GR), E Papachristoforou (Athens,GR), E Athanasiadi (Athens,GR), D Tsilingiris (Athens,GR), V Lambadiari (Athens,GR), J Barbetseas (Athens,GR)

C Kapelios1 , S Liatis1 , M Bonou1 , A Tentolouris1 , A Barmpagianni1 , M Driva1 , I Eleftheriadou1 , E Papachristoforou1 , E Athanasiadi1 , D Tsilingiris1 , V Lambadiari2 , J Barbetseas1 , 1Laiko University General Hospital - Athens - Greece , 2Attikon University Hospital - Athens - Greece ,


Background: Diabetes mellitus type 1 (DM1) primarily affects children and young, otherwise healthy, individuals. Cardiomyopathy presenting in these patients is mainly attributed to the direct effect of hyperglycemia. Pre-symptomatic diagnosis of myocardial dysfunction could facilitate timely and effective implementation of therapeutic interventions. However, the prevalence and risk factors of pre-symptomatic left ventricular systolic dysfunction (LVSD) in individuals with DM1 have not been systematically studied.

Purpose: To investigate the prevalence and risk factors for LVSD in asymptomatic patients with DM1.

Methods: We studied the association between presence of LVSD, assessed by abnormal values of global longitudinal strain (GLS), and a) patient history, b) demographic and clinical characteristics, c) autonomic nervous system function, measured using the battery of the 4 standardized tests proposed by Ewing, d) arterial stiffness, assessed by calculation of pulse wave velocity between the carotid and common femoral artery, e) body lipometry and f) prevalence and severity of diabetic complications in patients with DM1 and no history of cardiovascular disease. Results: We prospectively enrolled one hundred and forty-one asymptomatic patients with DM1. Forty-one (29.1%) were men, while mean age, disease duration and glycated hemoglobin were 37.6 ± 13.0 years, 19.2 ± 9.8 years and 7.4 ± 1.4%, respectively. LVSD, defined as a value of GLS> -19.6%, was prevalent in 65/141 (46.1%) patients. Patients with LVSD had a longer history of DM (21.0 ± 9.3 vs. 17.6 ± 10.1 years, P=0.045), a higher body mass index (BMI) (26.9 ± 5.1 vs. 24.3 ± 4.4 kg/m2, P=0.001) and higher levels of blood glycated hemoglobin (7.8 ± 1.5 vs. 7.1 ± 1.2%, P=0.007) compared with patients without LVSD.

In multivariable analysis, glycated hemoglobin levels (OR: 1.54; 95% CI: 1.11-2.13, P=0.011), duration of DM1 (OR: 1.05; 95% CI: 1.01-1.10, P=0.035), and waist circumference (WC, OR: 1.04; 95% CI: 1.01-1.07, P=0.015) or body mass index (BMI, used interchangeably with WC, OR: 1.11; 95% CI: 1.02-1.21, P=0.023) were independently associated with the presence of LVSD.

Conclusions: Our results indicate that apart from chronic hyperglycemia, increased adiposity, possibly indicating a dysmetabolic state, as expressed by a higher BMI/WC, may be implicated in the pathogenesis of LVSD, which leads to diabetic cardiomyopathy in patients with DM1. Interventions leading to weight loss could be considered as a therapeutic target to potentially prevent or/and reverse LVSD in these patients.

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