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J Diabetes Complications. 2014 Jan-Feb;28(1):22-8. doi: 10.1016/j.jdiacomp.2013.09.013. Epub 2013 Oct 7.

Prevalence, predictors and evolution of echocardiographically defined cardiac abnormalities in adults with type 1 diabetes: an observational cohort study.

Author information

1
Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia.
2
Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
3
Department of Cardiology, Austin Health, Melbourne, Australia.
4
Department of Endocrinology & Diabetes, St Vincent's Hospital & University of Melbourne, Melbourne, Australia.
5
Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Endocrine Centre of Excellence, Austin Health, Melbourne, Australia.
6
Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia. Electronic address: l.burrell@unimelb.edu.au.

Abstract

AIMS/HYPOTHESIS:

The 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.

METHODS:

Cardiac function and structure were prospectively investigated by comprehensive transthoracic echocardiographic techniques in asymptomatic adults with type 1 diabetes seen in the ambulatory care setting.

RESULTS:

We recruited 136 subjects (mean age 39 years, SD 14 years) with a median diabetes duration of 21 years [25(th), 75(th) 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/INTERPRETATION:

Subclinical 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.

KEYWORDS:

Cardiac disease; Diastolic dysfunction; Echocardiography; Left ventricular hypertrophy; Type 1 diabetes mellitus

PMID:
24210987
DOI:
10.1016/j.jdiacomp.2013.09.013
[Indexed for MEDLINE]
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