Diabetic cardiomyopathy: Pathophysiology, diagnostic evaluation and management

Abstract

Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population. Diabetes-related heart disease occurs in the form of coronary artery disease (CAD), cardiac autonomic neuropathy or diabetic cardiomyopathy (DbCM). The prevalence of cardiac failure is high in the diabetic population and DbCM is a common but underestimated cause of heart failure in diabetes. The pathogenesis of diabetic cardiomyopathy is yet to be clearly defined. Hyperglycemia, dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn implicated. The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DbCM. In the early stages of the disease diastolic dysfunction is the only abnormality, but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction. Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction, but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used recently for early detection of DbCM. The management of DbCM involves improvement in lifestyle, control of glucose and lipid abnormalities, and treatment of hypertension and CAD, if present. The role of vasoactive drugs and antioxidants is being explored. This review discusses the pathophysiology, diagnostic evaluation and management options of DbCM.

cAMP-dependent Protein Kinase (PKA) Signaling Is Impaired in the Diabetic Heart

“…Metabolic abnormalities include metabolic inflexibility caused by improper glucose uptake and oxidation and by lipotoxicity induced by lipid overload (5). Diabetes, in common with other forms of heart failure, has impairment of autonomic control and overstimulation of the sympathetic nervous system (6,7). The etiology of chronic cardiac stimulation in diabetes is characterized by sympathetic enhancement and parasympathetic withdrawal (3,8).…”

Molecular insights into diabetic cardiomyopathy

“…4 It is worth to be mentioned that there is increasing evidence of diabetics with abnormalities of left ventricular function in the absence of clinical heart disease and this is what called as diabetic cardiomyopathy. 3 The high morbidity and mortality for DbCM warrant aggressive clinical management.…”

“…3 The disease affects almost every tissue in the body and causes significant organ dysfunction with acute and long term complications that results in diabetes related morbidity and mortality. 3,4 Heart disease has been singled out as a major cause of death in patients with DM as diabetes increases the risk of developing heart disease by several fold. 3,5 Heart involvement in diabetes goes beyond the damage to coronary arteries due to the progress of atherosclerotic process.…”

“…4 The risk of CAD increases rapidly after the age of 40 in patients with type1 diabetes, and by the age of 55, 35% of the patients of both sexes have died because of coronary artery event, compared with 8% of men and 4% of women in general population.…”

Genomic Loci Evaluation with Albuminuria in New-Onset Insulin Dependent Diabetic Patients

“…Cardiovascular disease (CVD) accounts for the vast majority of morbidity and mortality in the diabetic patient population [1]. In 1999 diabetes was recognized as a coronary heart disease equivalent [2] and more recently it has been well recognized that the presence of diabetes increases the risk of heart failure by two to four fold [3].…”