# Cardiovascular function shows early impairment in asymptomatic adolescents diagnosed with type 1 diabetes mellitus: an ultrasound-derived myocardial work study

## TL;DR

This study shows that teenagers with type 1 diabetes have early signs of heart damage, even if they show no symptoms, using advanced ultrasound techniques.

## Contribution

This is the first study to investigate myocardial work in adolescents with type 1 diabetes, revealing early subclinical cardiac damage.

## Key findings

- Global longitudinal strain and myocardial work parameters were significantly lower in T1D adolescents compared to healthy controls.
- T1D adolescents had higher global wasted work and suboptimal glycemic control.
- Patients with hypertension or pre-hypertension had elevated pulse wave velocities.

## Abstract

Cardiac dysfunction and endothelial damage are known complications of type 1 diabetes mellitus (T1D) mainly affecting adults. However, some studies have shown that subclinical myocardial impairment already present during adolescence. Myocardial work (MW) has emerged as an afterload-independent tool that allows early identification of subclinical damage. This study aims to provide a comprehensive non-invasive cardiovascular evaluation of T1D adolescents using both conventional and advanced echocardiography.

We enrolled 31 patients, aged between 13 and 19 years, who were diagnosed with T1D for at least 10 years and were followed up by the Paediatric Diabetology Unit of our institution. We collected data relating to anthropometry, lifestyle, blood tests, glycemic control parameters, and conventional and advanced echocardiographic measurements. A comparison of MW parameters with the data from 31 age- and sex-matched healthy volunteers from a previous study in our lab was carried out.

In our population, the glycemic control parameters showed suboptimal control. While diastolic parameters were in the normal range for all the patients, E′ velocities and left atrial diameter were significantly worse in patients with poorer glycemic controls. Global longitudinal strain (GLS), global work index (GWI), and global work efficiency (GWE) were significantly lower in the T1D population compared to those in the healthy population (p < 0.001), while global wasted work was significantly higher in the T1D population (p < 0.001). Patients with stage 1 hypertension or a pre-hypertensive state exhibited pathological pulse wave velocities with values exceeding 8 m/s (>99th percentile).

To the best of our knowledge, this was the first study to investigate MW in T1D adolescents. The descriptive parameters of GLS and MW showed subclinical cardiac damage already during this timeframe. Therefore, these tools should be integrated into the cardiovascular assessment of diabetic adolescents, and preventive strategies should be implemented to maximize glycemic and pressure control effectiveness.