Progression of functional and structural cardiac alterations in young normotensive uncomplicated patients with type 1 diabetes mellitus

Objective We have recently observed that in young, normotensive patients wi th a type I diabetes mellitus and no macro or microvascular complications, large artery structure and function are already altered. This study has bee n done to assess whether this condition is also characterized by early alte rations in cardiac structure and function, and whether these alterations pr ogress with time. Design and methods In 56 insulin-treated, normotensive uncomplicated type I diabetic patients (age 35.0 +/- 2 years, means +/- SE) in good metabolic c ontrol, left ventricular wall thickness and diameter were measured by echoc ardiography together with left ventricular ejection fraction and diastolic function E/A (ratio between early and late ventricular filling), before and after 23 +/- 1 months. The same measurements were made in 20 age and sex-m atched subjects who served as controls (C). Results Compared to C, diabetic patients had a significant increase in left ventricular wall (septal plus posterior wall) thickness (+8.4%), left vent ricular mass index (+11%) and h/r ratio (left ventricular wall thickness/ve ntricular end diastolic diameter, +16.0%) whereas they showed a reduction o f E/A (-6%). In C, all echocardiographic values were unchanged after 2 year s. This was the case also for diabetic patients, except for left ventricula r ejection fraction and diastolic diameter which showed a significant reduc tion (-7.2%) and increase (+3.8%), respectively, with a reduction of ratio between LV wall thickness and diameter, h/r (-6.8%). Conclusions Uncomplicated type I diabetes mellitus is characterized by earl y structural and functional cardiac alterations. Some of these alterations show a measurable progression within a relatively short time span. (C) 2001 Lippincott Williams & Wilkins.