Resistin and right ventricular function in children with recently diagnosed type-1 diabetes mellitus: a case control study

Left ventricular longitudinal systolic dysfunction in children with type 1 diabetes mellitus: A systematic review and meta-analysis

OBJECTIVE

Children with type one diabetes mellitus (T1DM) may have subclinical myocardial insults but large heterogeneity exists among the reports. This study aimed to compare myocardial strain values of the left ventricle (LV) in paediatric patients with T1DM without overt cardiac disease and healthy controls.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science and Cochrane central register of controlled trials) were searched from inception to March 30, 2020. The studies reporting two-dimensional speckle tracking echocardiography in asymptomatic T1DM paediatric patients and control groups were included. Pooled mean strain values in each group and mean difference (MD) between the two groups for LV global longitudinal strain (LVGLS) and LV global circumferential strain (LVGCS) were assessed using a random effects model.

RESULTS

Ten studies (755 T1DM and 610 control) with LVGLS were included with 6 studies having LVGCS (534 T1DM and 403 control). Patients with T1DM had overall 3 percentage points lower LVGLS than healthy subjects (18.4 %, 95 % confidence interval [17.1, 19.6] vs 21.5 % [20.3, 22.7], MD = -3.01 [-4.30, -1.71]). A similar result was seen in LVGCS (18.7 % [15.4, 22.0] vs. 21.4 % [18.1, 24.6], MD = -3.10[-6.47, 0.26]) but not statistically significant. Meta-regression identified those with higher Haemoglobin A1c (HbA1c) had worse GLS.

CONCLUSIONS

Subclinical LV dysfunction among patients with T1DM occurs as early as in their childhood, while even EF is preserved. The longitudinal cardiac function is altered, but not the circumferential. GLS can be used to detect subclinical LV systolic dysfunction in paediatric population.

Lipid Biomarkers as Predictors of Diastolic Dysfunction in Diabetes with Poor Glycemic Control

Uncontrolled type-1 diabetes (T1DM) can lead to dyslipidaemia and albuminuria, which may promote cardiovascular injuries. However, some lipidemic factors could be useful in predicting cardiac dysfunction. Seventy-eight adolescents under insulin treatment due to a 6-year history of T1DM and were retrospectively examined. Glycemia, lipidemia, and albuminuria were measured in addition to development of cardiovascular abnormalities Both girls and boys showed higher HbA1c and fasting blood glucose and 27.1% females and 33.3% males exhibited microalbuminuria though their plasma levels of total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL) and high-density lipoproteins (HDL lipoproteins were in the normal range. They exhibited a preserved systolic function, but 50% of females and 66.6% of males had developed diastolic failures. Interestingly, girls with diastolic dysfunction showed significantly lower concentrations of HDL and higher TC/HDL and TG/HDL ratios. In fact, low HDL levels (OR 0.93; 95% CI 0.88-0.99; p = 0.029) and high TC/HDL (OR 2.55; 95% CI 1.9-5.45; p = 0.016) and TG/HDL (OR 2.74; 95% CI 1.12-6.71; p = 0.028) ratios associated with the development of diastolic complications. The cut-off values for HDL, TC/HDL, and TG/HDL were 49 mg/dL, 3.0 and 1.85, respectively. HDL and TC/HDL and TG/HDL ratios may be useful for predicting diastolic dysfunction in girls with uncontrolled T1DM.

Resistin family proteins in pulmonary diseases

The family of resistin-like molecules (RELMs) consists of four members in rodents (RELMα/FIZZ1/HIMF, RELMβ/FIZZ2, Resistin/FIZZ3, and RELMγ/FIZZ4) and two members in humans (Resistin and RELMβ), all of which exhibit inflammation-regulating, chemokine, and growth factor properties. The importance of these cytokines in many aspects of physiology and pathophysiology, especially in cardiothoracic diseases, is rapidly evolving in the literature. In this review article, we attempt to summarize the contribution of RELM signaling to the initiation and progression of lung diseases, such as pulmonary hypertension, asthma/allergic airway inflammation, chronic obstructive pulmonary disease, fibrosis, cancers, infection, and other acute lung injuries. The potential of RELMs to be used as biomarkers or risk predictors of these diseases also will be discussed. Better understanding of RELM signaling in the pathogenesis of pulmonary diseases may offer novel targets or approaches for the development of therapeutics to treat or prevent a variety of inflammation, tissue remodeling, and fibrosis-related disorders in respiratory, cardiovascular, and other systems.

Detection of occult right ventricular dysfunction in young Egyptians with type 1 diabetes mellitus by two-dimensional speckle tracking echocardiography

Background

Type 1 diabetes mellitus (T1DM) is a common chronic disorder of childhood and adolescence. T1DM induced cardiomyopathy has a different entity than T2DM as it relies on different pathophysiological mechanisms, and rarely coexists with hypertension and obesity. Evaluation of right ventricular (RV) function in diabetic patients has been neglected despite the important contribution of RV to the overall cardiac function that affects the course and prognosis of diabetic cardiomyopathy (DCM).

Objective

To assess RV myocardial performance in asymptomatic T1DM using speckle tracking and standard echo parameters and correlate it with functional capacity using treadmill stress test.

Patients and methods

Thirty-nine patients with TIDM (Group 1, mean age 18.2 ± 1.7y, BMI = 26.2 ± 3.9 kg/m²), without cardiac problems and 15 apparently healthy matched subjects as a control group (Group 2, mean age 18.8 ± 2.3 y, BMI = 22.8 ± 3.3 kg/m²) were enrolled. RV function was evaluated using conventional, tissue Doppler and 2D speckle tracking echocardiography (2D-STE). The peak RV global longitudinal strain (RV-GLS) was obtained. Functional capacity was assessed by treadmill exercise test and estimated in metabolic equivalent (METs).

Results

In this study; the diabetic group showed statistically highly significant decrease in the average RV-GLS (−14.0 ± 6.9 in group 1 vs. −22.7 ± 2.5 in group 2, P < 0.001), significant decrease in RV S velocity (9.5 ± 2.2 in group 1 vs. 11.5 ± 1.8 in group 2, P < 0.05), significantly reduced E/A ratio (1.0 ± 0.2 in group 1 vs. 1.1 ± 0.1 in group 2, P < 0.05), and highly significant increased E/Em ratio (7.9 ± 3.2 in group 1 vs. 5.2 ± 0.7 in group 2, P < 0.001). We did not found any significant differences between the two groups regarding the other echocardiographic or functional capacity parameters.

Conclusion

In asymptomatic patients with T1DM, in addition to RV diastolic dysfunction, early (subclinical) RV systolic dysfunction is preferentially observed with normal RV and left ventricular (LV) ejection fraction (EF). 2D-STE has the ability to detect subclinical RV systolic dysfunction.

Oxidative stress and cardiac dysfunction in children with chronic renal failure on regular hemodialysis

OBJECTIVE

The objective of this study was to evaluate cardiac function in children with end-stage renal disease (ESRD) on regular hemodialysis using speckle tracking echocardiography (STE) and correlate results with plasma glutathione level as a marker of oxidative stress.

METHODS

The study involved 30 children with ESRD and 30 healthy controls. The plasma glutathione and C-reactive protein (CRP) levels were measured, and cardiac function was evaluated using conventional echocardiography and STE.

RESULTS

Plasma glutathione levels were significantly lower and CRP significantly higher in patients than in controls. Children with ESRD had significant systolic and diastolic cardiac dysfunctions detected by STE compared with controls. Conventional echocardiography failed to detect these dysfunctions. There was significant increase in left-ventricular relative wall thickness (LV-RWT) in patients, especially those with hypertension, compared with the control group. There was also significant impairment of LV and right-ventricular (RV) global longitudinal strain (GLS) and torsion; however, LV-GLS was significantly better in hypertensive than in normotensive patients. The degree of impairment in GLS and cardiac torsion negatively correlated with plasma glutathione levels.

CONCLUSION

Significant oxidative stress was present in children with ESRD and was correlated with the degree of cardiac dysfunction detected early using the new cardiac imaging modality, STE.