CARDIOVASCULAR STATUS IN YOUNG-PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Background Although the existence of diabetic cardiomyopathy in adults is firmly established, the presence of cardiac abnormalities in young diabetic patients is not universally accepted. We sought to determine the early stages of cardiac derangement and whether they are associat ed with renal dysfunction. Methods and Results Thirty-nine patients (2 9 boys; mean age, 17.6+/-3.4 years) with insulin-dependent diabetes me llitus underwent echocardiography and timed overnight urine collection . Echocardiographic evaluation consisted of left ventricular mass, per formance (shortening fraction, velocity of circumferential fiber short ening, stroke volume, and cardiac index), preload (end-diastolic dimen sion and volume), afterload (end-systolic wall stress and systemic vas cular resistance), and contractility (velocity of fiber shortening rel ative to wall stress). Creatinine clearance and albumin excretion were measured from the urine sample. Glycosylated hemoglobin levels were m easured; height and weight were measured; and Quetelet index (weight/h eight(2)) was calculated. These data were compared with control data. Left ventricular mass (26+/-6 versus 22+/-6 g/ht(2.7),P<.01), the inde xes of performance, blood pressure, and contractility (0.14+/-0.14 ver sus 0.003+/-0.03 circumference/s, P<.0003) were significantly higher i n the diabetic patients than in control subjects. To evaluate the corr elates of left ventricular mass and contractility in the diabetic pati ents, univariate and multiple regression analyses were performed. Sign ificant univariate correlations of mass included albumin excretion (r= .36, P<.02), glycosylated hemoglobin (r=.35, P<.04), and stroke volume (r=.34, P<.03). A multivariate model included Quetelet index, albumin excretion, and duration of diabetes. Significant univariate correlati ons of contractility included insulin dosage (r=-.36, P<.02), creatini ne clearance (r=.40, P<.02), and Quetelet index (r=.34, P<.03). A mult ivariate model included insulin dosage and creatinine clearance. Concl usions Early onset of diabetes mellitus is associated with increased l eft ventricular mass, performance, contractility, and blood pressure. These cardiovascular findings are correlated with increased creatinine clearance and microalbuminuria. These relations suggest that alterati ons in cardiovascular and renal function may occur in parallel in adol escents with insulin-dependent diabetes mellitus.