Microcirculation disorders and structural and functional left ventricular abnormalities in patients with type 1 diabetes complicated by ketoacidosis

Abstract

Aim. To assess the patterns of microcirculation disorders and its effect on the left ventricular (LV) structure and function in patients with type 1 diabetes (T1D) complicated by diabetic ketoacidosis (DKA).Material and methods. The study included 128 patients with T1D complicated by DKA. Echocardiography was performed according to the standard technique. To study the microcirculation and vascular tone regulation, we used a laser Doppler flowmetry (LDF) using the LAKK-02 machine (Lazma, Russia).Results. In patients with T1D complicated by DKA, there was an increase in thepassive blood flow modulation with a depression of active factors. The most pronounced changes are recorded in 1-5 days of the disease. Along with this, a spectral redistribution in favour of respiratory and cardiac microcirculation ranges was demonstrated. With DKA, the myocardial remodelling is recorded: an increase in left atrial (LA) size by 5,6%, LV end systolic and diastolic dimension and volume by 5,3% and 6,7%, respectively, LV mass by 17,3% and LV mass index by 17,8%. Decreased LV ejection fraction (EF) in comparison with healthy individuals was obtained. Significant unidirectional changes in these parameters were revealed in comparison with the T1D patients without DKA.Conclusion. In patients with T1D complicated by DKA, the microcirculation decreases, as a result of which the adequate tissue supply is limited, vascular resistance and hemodynamic load increases, which leads to LV structural and functional changes.

Keywords

• type 1 diabetes mellitus
• ketoacidosis
• microcirculation
• cardiohemodynamics