Diabetic Cardiomyopathy as a Clinical Entity: Is It a Myth?

Abstract

Dilated cardiomyopathy (DCM) is a common form of cardiomyopathy that affects the cardiac muscle. It is a life-threatening condition that causes heart failure as it decreases the myocardial ability to pump sufficient blood throughout the body. Numerous causes trigger DCM without pathophysiology; however, the key concept is a decrease in the systolic function of either the left ventricle or of both the left and right ventricles. Long-term diabetes plays an important role in the pathogenesis of DCM in the form of diabetic cardiomyopathy. Diabetic cardiomyopathy is a non-ischemic form of DCM, which is associated with diabetes. It is unrelated to atherosclerosis and hypertension. The PubMed and Google Scholar databases were used to identify the relevant studies related to diabetes and DCM. We found that diabetes was associated with cardiac muscle injury by activating the renin-angiotensin-aldosterone system, myocardial inflammation, and fibrosis. Based on the available data, we concluded that there is strong evidence to support the interrelation of DCM and diabetes.

Diabetes Mellitus Type 2, Prediabetes, and Chronic Heart Failure

“…During stage IV, HF is developed due to overt ischemia and infarct [102]. Hyperglycemia, hyperinsulinemia, inflammation, and hyperlipidemia due to diabetes can lead to cardiac dysfunction along with changes in the structure of the heart [106]. In the case of CMiPD, insulin resistance causes glucose metabolism in the cardiac myocyte to be altered; more specifically, glucose uptake, glycolytic activity, and oxidation of pyruvates are decreased [102].…”

Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management

“…In addition and parallel to structural changes of the heart, diabetes-associated conditions such as hyperglycemia, hyperinsulinemia, inflammation, and hyperlipidemia can alter cardiac function (Fig. 1 ) [ 39 ]. In CMiPD, the heart muscle shows an impaired glucose metabolism due to insulin resistance, characterized by a reduced glucose uptake, a reduced glycolytic activity, and a reduced pyruvate oxidation [ 35 ].…”

Diabetic heart disease: A clinical update

“…Activation of proinflammatory cytokines, production of ROS, dysfunction of mitochondria and ER in cardiac tissue are the key operating mechanisms that contribute towards cardiac remodelling, fibrosis, and diastolic dysfunction. These are triggered due to the combined effects of enhanced deposition of AGEs and lipotoxic metabolites, activation of RAAS, altered calcium homeostasis and abnormal insulin signalling pathways through activation of the mammalian target of rapamycin (mTOR)-S6 kinase 1 pathway leading to abnormal intracellular glucose transport in cardiomyocytes[ 112 ]. Figure 3 illustrates the complex pathophysiological mechanisms involved in the development of DCM.…”