Subclinical myocardial dysfunction assessed by two-dimensional speckle-tracking echocardiography in children and adolescents with prediabetes

Abstract

Aim Prediabetes is associated with an increased risk of cardiovascular morbidity. Although cardiovascular dysfunction is well documented in diabetes, evidence regarding cardiac involvement in children with prediabetes remains limited. This study aimed to evaluate subclinical myocardial dysfunction using two-dimensional speckle-tracking echocardiography (2D-STE) in asymptomatic children and adolescents with prediabetes. Methods Thirty-two children with obesity and prediabetes and 28 controls underwent laboratory evaluation and echocardiographic assessment, including conventional echocardiography, tissue Doppler imaging, and 2D-STE. Results Prediabetic children demonstrated significantly higher left ventricular end-systolic volume, left ventricular mass, left ventricular internal diameters, and posterior wall thickness. Diastolic function parameters were impaired, with lower tricuspid E/A ratios and reduced mitral septal and lateral e′ velocities. Global longitudinal strain values were also significantly lower in the prediabetes group. In contrast, conventional systolic function parameters, including left ventricular ejection fraction, fractional shortening, and tricuspid annular plane systolic excursion, were similar between groups. After adjustment for body mass index and age, only the association between prediabetes and the tricuspid E/A ratio remained significant. Conclusion Children with prediabetes showed subtle differences in selected echocardiographic parameters despite preserved conventional systolic function. However, after adjustment for body mass index (BMI) and age, only the tricuspid E/A ratio remained significantly associated with prediabetes. These findings should be considered exploratory, and their clinical significance requires confirmation in larger longitudinal studies.