The relation between type 1 diabetes and cardiac structure and function in children is poorly documented. We used 2D speckle strain imaging to investigate whether children and adolescents with type 1 diabetes have early echocardiographic signs of subclinical cardiac dysfunction and whether state of metabolic control and diabetes duration are of influence.

Standard 2D echocardiography, mitral TDI and 2D speckle strain imaging were prospectively performed in type 1 diabetic children and compared them to age and sex-matched healthy control subjects. Standard echocardiographic indices of global systolic and diastolic function, early peak diastolic mitral velocity (Ea), longitudinal strain (LS), radial strain (RS) and circumferential strain (CS) were investigated.

Overall 49 consecutive type 1 diabetic children (age: 12.3 [6-18] years; BMI: 19±2.8; males: 20) were compared to 49 control subjects. There was no difference between two groups for mean arterial blood pressure, heart rate, left ventricular ejection fraction, left ventricular mass, conventional diastolic mitral Doppler parameters (E, E/A, MTD) and Ea. A significant decrease of LS was identified in type 1 diabetic children while RS and CS did not differ. LS was positively correlated with HbA_1c (r: 0,28; p<0,001) and with diabetes duration (r: 0,20; p<0,001).

We demonstrated that left ventricular longitudinal myocardial strain is decreased in young patients with uncomplicated type 1 diabetes. Metabolic control may be the main risk factor for these myocardial changes. This finding might be considered a very early preclinical alteration potentially related to subsequent development of diabetic cardiomyopathy.