Investigation of the effect of epicardial adipose tissue thickness on cardiac conduction system in children with type 1 diabetes mellitus

Evaluation of epicardial adipose tissue in children with type 1 diabetes

INTRODUCTION

Epicardial adipose tissue (EAT), the visceral fat surrounding the heart between the myocardium and visceral pericardium, intersects with Type 1 diabetes (T1D). This review aims to elucidate the intricate association between EAT and childhood T1D.

MATERIALS AND METHODS

In this retrospective study, two pediatric groups were involved children with type 1 diabetes, and healthy children. Epicardial fat thickness was measured appropriately, and the study documented HbA1c levels and time to diabetes diagnosis for comprehensive analysis.

RESULTS

Encompassing 51 children with T1D and 69 healthy controls, revealed that children with type 1 diabetes had a mean HbA1c level of 9.4 ± 0.2, and a mean insulin dose of 0.94 units/kg/day. Epicardial adipose tissue (EAT) values were significantly higher in the Type 1 DM group. It has been shown that epicardial fat thickness may have a specific and sensitive value in type 1 diabetics.

DISCUSSION

The increased presence of epicardial fat tissue in children with type 1 diabetes is highlighted, prompting the consideration of various mechanisms. However, the complexity of this relationship underscores the need for further studies to provide a more comprehensive understanding of the underlying factors. Ongoing research in this area is crucial for advancing our knowledge and potential therapeutic interventions.

IMPACTS

Cardiac complications are one of the most important causes of morbidity and mortality in people with type 1 diabetes. Being able to detect cardiological complications of diabetes at an early stage contributes to morbidity. We found that epicardial fat tissue thickness was thicker in children with type 1 diabetes than in healthy children. Epicardial fat tissue thickness may be associated with poor control in children with type 1 diabetes and maybe a guide in terms of cardiac risks.

Association of Epicardial Fat with Diastolic and Vascular Functions in Children with Type 1 Diabetes

We aimed to examine the relationship between epicardial fat thickness (EFT) measured by echocardiography and cardiovascular functional parameters in children with type 1 diabetes mellitus (T1DM). The study included 50 type 1 diabetic children and 50 healthy subjects matched by sex, age, and body mass index. In addition to laboratory tests, all participants underwent transthoracic echocardiography for EFT, cardiac dimensions and left ventricular functions, and ultrasonographic examination for brachial artery flow-mediated dilation (FMD) response and carotid intima-media thickness (CIMT). Multivariate linear regression was used to analyze the relationship between EFT and CIMT, FMD, lateral mitral E' velocity, and mitral E/E' ratio. EFT was significantly increased in diabetic children compared with controls (P < 0.001). In comparison with controls diabetic children had significantly increased mitral A, decreased lateral mitral E', decreased mitral E/A ratio, decreased lateral mitral E'/A' ratio, and increased mitral E/E' ratio (P < 0.001). FMD response was significantly lower in diabetic group versus controls (P < 0.001) and CIMT was significantly increased in diabetics versus controls (P = 0.03). EFT was negatively correlated with lateral mitral E' velocity (r =  - 0.613, P < 0.001), positively correlated with mitral E/E' ratio (r = 0.60, P < 0.001), positively correlated with CIMT (r = 0.881, P < 0.001), and negatively correlated with FMD (r =  - 0.533, P < 0.001). By multivariate regression analysis, the EFT was independently and positively associated with CIMT mean and E/E' mean and negatively associated with FMD mean and E' mean. The cut-off point for EFT as predictor of endothelial dysfunction was 6.95 mm. Our findings suggest that children with T1DM have subclinical LV diastolic and vascular endothelial dysfunctions associated with increased EFT.