Diabetic cardiomyopathy: mechanisms, diagnosis and treatment

Abstract

Independent of the severity of coronary artery disease, diabetic patients have an increased risk of developing heart failure. This clinical entity has been considered to be a distinct disease process referred to as 'diabetic cardiomyopathy'. Experimental studies suggest that extensive metabolic perturbations may underlie both functional and structural alterations of the diabetic myocardium. Translational studies are, however, limited and only partly explain why diabetic patients are at increased risk of cardiomyopathy and heart failure. Although a range of diagnostic methods may help to characterize alterations in cardiac function in general, none are specific for the alterations in diabetes. Treatment paradigms are very much limited to interpretation and translation from the results of interventions in non-diabetic patients with heart failure. This suggests that there is an urgent need to conduct pathogenetic, diagnostic and therapeutic studies specifically in diabetic patients with cardiomyopathy to better understand the factors which initiate and progress diabetic cardiomyopathy and to develop more effective treatments.

<b>Downregulation of Peroxisme Proliferator Activated Receptor Gamma Co-Activator 1&alpha; in Diabetic Rats</b>

“…9,11,20) The correlation between diabetic ischemic heart and unfavorable clinical outcomes is widely recognized. 1,3,5,[7][8][9]11,20) Additionally, clinical observational studies 21,22) have clearly demonstrated that many DM patients without hypertension, valvular heart disease, or obstructive epicardial vessel disease presented with CHF. These kinds of heart diseases have previously been categorized as diabetic cardiomyopathy.…”

Diagnostic Value of Poor R‐Wave Progression in Electrocardiograms for Diabetic Cardiomyopathy in Type 2 Diabetic Patients

“…2 Among the early pathological changes, diastolic dysfunction and LV hypertrophy can be seen to accompany preserved LV systolic function. 2,4 -6,8,19 Heart failure can occur after these pathological changes in subsequent years.…”

“…During follow-up, fasting blood glucose and HbA1c levels remained higher, and more patients needed insulin treatment to control their blood glucose among patients with poor R-wave progression.The main pathophysiologic event resulting from hyperglycemia is an increase in glycolysis end-products, and as a result nitric oxide becomes deactivated. 2 Hyperglycemia activates the local myocardial renin-angiotensin and endothelial systems, and consequently myocyte necrosis and fibrosis increase. 8,20 In previous studies, the degree of diastolic dysfunction 562 Clin.…”

“…33, 9, 559 -564 (2010) was correlated with HbA1c and insulin levels. 2,10,21 Diastolic dysfunction could be detected in 52%-60% of the patients in echocardiography even under close glycemic control. 20 It is also known that hyperinsulinemia can cause LV hypertrophy.…”

“…1 Cardiovascular disease is a serious of complication of diabetes and is responsible for 80% of the deaths among diabetics. 2 Although coronary artery disease is very common, heart failure is also a major cause of mortality and morbidity in patients with diabetes mellitus. 3 Up to 75% of patients with unexplained idiopathic dilated cardiomyopathy were found to be diabetic.…”