الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 207 |  |  |
| | | from | 207 | | |
Abstract
Diabetes mellitus is one of the most common chronic diseases in br children - adolescents with increased cardiovascular morbidity and br mortality. Its incidence is rising and it is becoming a severe health problem br in many countries. br The existence of a diabetic cardiomyopathy has been proposed as br evidence has accumulated for the presence of myocardial dysfunction in br diabetic patients in the absence of ischemic, valvular or hypertensive heart br disease. br The pathogenesis of this myocardial dysfunction is not clearly br understood. Microangiopathy, increased extracellular collagen deposition, or br abnormalities in calcium transport alone or in combination are considered to br be associated with this dysfunction. br Diastolic dysfunction has been described as an early sign of this br diabetic heart muscle disease preceding the systolic damage - abnormalities br in diastolic performance have been first demonstrated by cardiac br catheterization and subsequently by using echocardiography. br With the advent of recent echocardiographic techniques such as br Tissue Doppler Imaging (TDI), the ability to accurately detect diastolic br dysfunction has significantly improved. Tissue Doppler Image have br provided information to overcome some technical limitations concerning br traditional Doppler echocardiographic studies of diastolic function. br However, the prognostic importance of subclinical diastolic br dysfunction and the possibilities for intervention are not fully known. br Eventually, despite numerous studies, evidence of an intrinsic diastolic br dysfunction in diabetes mellitus remains questionable. Indeed, quite br contradictory results have been reported. They have been obtained in small, br inhomogeneous populations, with sometimes confounding factors, using br various echocardiographic indices with known limitations. br This study was carried out to assess right and left ventricular function br in children with type 1 diabetes mellitus using conventional - Tissue br Doppler imaging echocardiography - to correlate cardiac function with br epidemiologic and laboratory factors (sex of patients, diabetes duration and br state of metabolic control). br The present work was conducted on thirty patients (16 males -14 br females) suffering -#102;-#114;-#111;-#109; type 1 diabetes mellitus “ Group 1” and twenty of br apparently normal children with comparable age, sex - socioeconomic br status as controls (11 males and 9 females) “ Group 2”. br All cases were collected -#102;-#114;-#111;-#109; the Pediatric Endocrinology Clinic and br Inpatient Pediatric Department Of Menoufiya University Hospital in the br period -#102;-#114;-#111;-#109; April 200٩ to April 2012. br All patients and controls were subjected to the following: br (1) Detailed history. br (2) Thorough clinical examination. br (3) Investigations: br Laboratory investigations: Glycated Hb (HBA1c). br Electrocardiography (ECG). br Echocardiographic and Doppler examination including: br • Two dimensional (2-D) and M-mode echocardiography: with br measurement of left ventricular end systolic and end diastolic br dimensions - volumes, Stroke volume , left ventricular ejection br fraction and fraction shortening. br • Conventional Doppler echocardiography: with measurement of br the mitral and tricuspid Peak early (E) and late (A) filling br velocities, E/A ratio - Deceleration time (DT) of E wave. br • Tissue Doppler Imaging (TDI): with measurement of Peak E`- br A` velocities, E`/A` ratio IVRT, IVCT, ET, Tei index of the lateral br mitral annulus, basal septal - lateral tricuspid annulus. br Our results showed that: br » Children with type 1 DM without ischemic, valvular or br hypertensive disease have impaired diastolic function in both left br and right ventricles before the development of systolic dysfunction br when assessed with either conventional or tissue Doppler br echocardiography. br » Resting heart rate (RHR) in diabetics showed a significant positive br correlation with mitral A flow velocity and a significant negative br correlation with mitral and tricuspid E/A ratio, So inreased RHR br could be used as a rapid screening test for diabetic myocardial.