MRI Assessment of Aortic Stiffness in Children & Adolescents with Type 1 Diabetes Mellitus

Abstract

T ype 1 diabetes mellitus (DM) leads to functional and structural arterial vessel wall alterations, resulting in stiffening of the arterial system In turn, increased arterial wall stiffness is an important predictor of cardiovascular disease in type 1 DM. A close relationship has been established between indexes of arterial stiffening and progressive micro vascular damage in the kidneys that leads to renal failure. The mechanism of this relationship is complex, because a decrease in aortic wall elasticity may contribute to renal dysfunction by transmission of high-pulsatile flow to the kidneys, and, conversely, renal dysfunction may also contribute to increased aortic stiffness. Most of the studies describing arterial stiffness and the kidneys have been conducted in patients with chronic kidney disease, and similar findings have been noted in patients with DM with microalbuminuria. However, whether type 1 DM is associated with increased aortic stiffness, independently of renal dysfunction, has not been studied in detail before, to our knowledge. Therefore, we selected patients with type 1 DM with normal renal function to avoid the possible confounding effect of renal dysfunction that may aggravate reduction in vascular elasticity. On the other hand, diabetic nephropathy is one of the major complications of type 1 DM, and a gradual progressive process of aortic stiffening, renal damage, and their interaction can be assumed in chronic type 1 DM disease, appearing before the onset of clinically detectable renal damage. This notion could be substantiated if an independent relationship could be established between aortic stiffness and renal function within the normal range in type 1 DM.