Global Longitudinal Strain Is€Not€Impaired€in Type 1 Diabetes Patients€Without Albuminuria

Fro Ge De Co su Ca Ad Na Ca the OBJECTIVES The purpose of this study was to investigate if systolic myocardial function is reduced in all patients with type 1 diabetes (T1DM) or only in patients with albuminuria. BACKGROUND Heart failure is a common cause of mortality in T1DM, and a specific diabetic cardiomyopathy has been suggested. It is not known whether myocardial dysfunction is a feature of T1DM per se or primarily associated with diabetes with albuminuria. METHODS This cross-sectional study compared 1,065 T1DM patients without known heart disease from the outpatient clinic at the Steno Diabetes Center with 198 healthy control subjects. Conventional echocardiography and global longitudinal strain (GLS) by 2-dimensional speckle-tracking echocardiography was performed and analyzed in relation to normoalbuminuria (n 1⁄4 739), microalbuminuria (n 1⁄4 223), and macroalbuminuria (n 1⁄4 103). Data were analyzed in univariable and multivariable linear regression models adjusted for confounding factors including conventional risk factors, medication, and systolic and diastolic dysfunction. Investigators were blinded to degree of albuminuria. RESULTS Mean age was 49.5 years, 52% men, mean glycated hemoglobin 8.2% (66 mmol/mol), mean body mass index 25.5 kg/m, and mean diabetes duration 26.1 years. In unadjusted analyses, GLS differed significantly between T1DM patients and control subjects (p 1⁄4 0.02). When stratified by degrees of albuminuria, the difference in GLS compared with control subjects was 18.8 2.5% versus 18.5 2.5% for normoalbuminuria (p 1⁄4 0.28), versus 17.9 2.7% for microalbuminuria (p 1⁄4 0.001), and versus 17.4 2.9% for macroalbuminuria (p < 0.001). Multivariable analyses, including clinical characteristics, diastolic and systolic dysfunction, and use of medication, did not change this relationship. CONCLUSIONS Systolic function assessed by GLS was reduced in T1DM compared with control subjects. This difference, however, was driven solely by decreased GLS in T1DM patients with albuminuria. T1DM patients with normoalbuminuria have systolic myocardial function similar to healthy control subjects. These findings do not support the presence of specific diabetic cardiomyopathy without albuminuria. (J Am Coll Cardiol Img 2015;8:400–10) © 2015 by the American College of Cardiology Foundation. m the *Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; ySteno Diabetes Center, ntofte, Denmark; zInstitute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, nmark; xNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of penhagen, Copenhagen, Denmark; and the kFaculty of Health, University of Aarhus, Aarhus, Denmark. This work was pported by The European Foundation for the Study of Diabetes/Pfizer European Programme 2010 for Research into rdiovascular Risk Reduction in Patients with Diabetes and The Danish Heart Foundation (12-04-R90-A3840-22725). ditional funding has been received from The Torben & Alice Frimodts Foundation, Carl & Ellen Hertz’ Legat til Dansk Læge-og turvidenskab, and The Beckett Foundation. Dr. Sogaard has received research grants from, and has given talks for GE Health re, Biotronik, and Bayer. Dr. Andersen has been an advisory board member for Abbott; has stock in Novo Nordisk; and Steno Diabetes Center is an affiliate of Novo Nordisk. Dr. Rossing has board memberships in AstraZeneca/Bristol-Myers AB BR E V I A T I O N S