932 ECHOCARDIOGRAPHIC CARDIAC DISEASE IN ADULTS WITH TYPE 1 DIABETES

Background: Patients with type 1 diabetes (T1DM) are at increased risk of cardiac death. This study assessed the prevalence and predictors of echocardiographically determined cardiac abnormalities in adults with T1DM. Methods: Cardiac structure and function were assessed by transthoracic echocardiography in 193 T1DM patients attending a Diabetes Clinic as part of a complication surveillance program. Predictors of an abnormal echocardiogram were identified using logistic regression analysis. Results: The mean (±SD) age was 44±15y and median diabetes duration, 18y [25th, 75th interquartile range; 9, 27]. An abnormal echocardiogram was present in 34%; of these 42% had left ventricular hypertrophy (LVH), 77% had diastolic dysfunction; and 6% had systolic ± diastolic dysfunction. Those with an abnormal echocardiogram were significantly older with a higher BMI, longer duration of diabetes, and were more likely to have hypertension, micro- and macro-vascular disease, and reduced creatinine clearance (all, p<0.05). The risk of an abnormal echocardiogram increased 13-fold in those aged >40y [odds ratio (OR) 13.6 (95% CIs, 2.7-68.5), p=0.002), 5-fold with diabetes duration >10y [OR 5.3 (1.1-24.8), p=0.03] and 3-fold if hypertension was present (p=0.047). Increased BMI (p=0.04) and reduced creatinine clearance (p=0.02) were also associated with the risk of an abnormal echocardiogram. Micro- and macro-vascular complications were not independent predictors of an abnormal echocardiogram. Conclusion: One third of patients with T1DM have an abnormal echocardiogram. It is known that LVH and systolic dysfunction are associated with adverse outcomes, but further studies are needed to determine the prognostic significance of diastolic dysfunction in this population.