Role of epicardial fat thickness and irisin levels in early prediction of cardiac dysfunction in children and adolescents with type 1 diabetes mellitus

Introduction
to assess the role of epicardial fat thickness and irisin in early prediction of cardiac dysfunction in children and adolescents with type 1 diabetes mellitus and correlate them with echocardiographic parameters and lipid profile.

Material and methods
Sixty-three type 1 diabetic children and adolescents were recruited from the Pediatric Diabetic Clinic, National Research Centre. Thirty-four healthy children, matched for age and sex, served as controls. All patients were insulin dependent with at least 3-year duration of the disease since diagnosis. Venous blood was withdrawn under complete aseptic precautions from fasting subjects; sera were collected for evaluation of glycated haemoglobin (HbA1C), lipid profile and irisin levels. Two-dimensional echocardiography was performed for measurement of interventricular septal thickness in diastole, left atrial diameter (LAD), aortic root diameter, mitral E and A wave, left ventricular internal dimension in diastole, percent fractional shortening (FS%), percent ejection fraction, left ventricular mass, and epicardial fat thickness. Patients were further divided into two groups according to their glycaemic control (< 7.00, ≥ 7.0) for comparison of echocardiographic parameters and irisin.

Results
Echocardiographic study revealed a statistically significant increase in LAD, FS%, and epicardial fat thickness in patients compared to controls (p = 0.000, 0.014, and 0.000 respectively). Triglyceride and irisin levels were significantly increased in patients compared to controls (p = 0.012, 0.015 respectively). Epicardial fat thickness positively correlated with left atrial diameter (p = 0.009) and left ventricular mass (p = 0.000). Irisin was positively correlated with E/A ratio (p = 0.05).

Conclusions
The findings of the present study probably indicate the beginning of a state of metabolically induced diastolic dysfunction. Echocardiography should be performed in type 1 diabetic patients on a regular basis for early detection of subclinical cardiac dysfunction.