Strain imaging in uncomplicated type 1 diabetes patients for risk stratification: it ain't as "sweet" as it sounds.

SEE PAGE 400 S afety, reliability, ease of use, and relatively low cost has placed echocardiography at the forefront of imaging modalities utilized in the assessment of cardiac function. Over the last 2 decades, techniques to detect pre-clinical cardiac dysfunction, such as the echocardiographic estimation of myocardial strain and strain rate, have been developed. Myocardial strain measures the deformation of tissues in response to stress (1), and speckle tracking echocardiography (STE) has emerged as the preferred method to estimate strain (2–4). In an effort to determine the clinical utility of STE, the prognostic importance of strain has been assessed in a variety of clinical scenarios. Global longitudinal strain (GLS), as derived from STE, has been shown to be an independent and superior predictor of mortality when compared with “traditional” measures of systolic function, such as left ventricular (LV) ejection fraction or wall motion score index (5,6). Both type 1 and type 2 diabetes mellitus (DM) represent a multisystem disorder associated with substantial cardiovascular morbidity and mortality. Despite being an area of intensive research, the pathophysiology driving the disease process in patients with type 1 DM remains poorly understood, and the approach to management has generally followed