Speckle Tracking Analysis of the Left and Right Heart in Type 1 Diabetes Patients with End-Stage Renal Disease Awaiting Simultaneous Pancreas–Kidney Transplantation

Background/Objectives: Diabetic cardiomyopathy is an under-recognized complication of type 1 diabetes mellitus (T1DM), often co-existing with diabetic nephropathy. This study investigates whether patients with T1DM and end-stage renal disease (ESRD) undergoing simultaneous pancreas–kidney transplantation (SPKT) show echocardiographic signs of cardiomyopathy prior to surgery and explores whether cardiac changes are more attributable to diabetes itself or to chronic kidney disease. Methods: We retrospectively analyzed preoperative echocardiographic data of 16 SPKT patients with T1DM and ESRD, using 2D speckle tracking for strain assessment. Data were compared to individually matched control groups: (1) ESRD patients without diabetes (n = 20) and (2) healthy controls (n = 48). Left and right ventricular/atrial function and structure were analyzed, including 2D speckle-tracking analysis. A mixed-effects model adjusted for age, sex, coronary artery disease, and hypertension. Results: SPKT patients exhibited significant structural changes in the left heart, including increased left ventricular mass and left atrial volume index, alongside reduced global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) compared to healthy controls. GRS and GCS were significantly lower in the SPKT group than in the ESRD group without diabetes. Left atrial strain and strain rates were reduced in both disease groups. Right ventricular and atrial strain parameters did not significantly differ between groups. Mixed model analysis confirmed significant strain differences in the left ventricle even after adjusting for confounders. Conclusions: T1DM patients with end-stage nephropathy awaiting SPKT show echocardiographic abnormalities compatible with subclinical myocardial dysfunction, with predominant involvement of the left heart. Compared to non-diabetic ESRD patients, the diabetic cohort exhibited greater impairment in left ventricular strain parameters, supporting a pathophysiologic role of diabetes independent of kidney disease. Speckle-tracking analysis demonstrated potential utility for detecting early signs of myocardial dysfunction in this high-risk population.