Present Insights on Cardiomyopathy in Diabetic Patients

Abstract

The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management. The novelty of this review is the role of CAN and reduction of blood pressure descent during sleep in the development of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium abnormalities. Considering that DCM could be asymptomatic for a long period and progress to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type 2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities in these tests in the attempt of reducing cardiovascular morbidity and mortality.

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

“…These are triggered by hyperglycemic and lipotoxic anomalies related to insulin resistance, the prominent feature in type 2 diabetes [21,22,23,24,25,26,27,28,29,30]. Figure 2 summarizes the cellular, structural, and functional anomalies, the main imaging features, and the serological biomarkers involved in the earlier stages of diabetic cardiomyopathy [23,25,31,32,33,34,35,36,37].…”

Inhibitory Effects of Momordicine I on High-Glucose-Induced Cell Proliferation and Collagen Synthesis in Rat Cardiac Fibroblasts

“…DCM is characterized by myocardial fibrosis, left ventricular hypertrophy, and compromised left ventricular systolic and diastolic functions [ 2 , 4 , 5 ]. Left ventricular diastolic dysfunction is a major characteristic of DCM, and recent studies revealed that over 50% of asymptomatic diabetic patients have diastolic dysfunction [ 1 , 6 ]. Cardiac fibroblasts are enmeshed in the myocardium and play a crucial role in maintaining the integrity and homeostasis of the interstitial matrix in the adult heart [ 7 – 9 ].…”

Assessment of real-time three-dimensional echocardiography as a tool for evaluating left atrial volume and function in patients with type 2 diabetes mellitus

“…This increased risk of heart failure is believed to be attributable to metabolic changes associated with insulin resistance and hyperglycemia, which can lead to disordered cardiac energy metabolism, cardiac cell hypertrophy, fibrosis, myocardial microcirculation damage, and structural and functional changes within the cardiac tissue. Early pre-symptomatic manifestations of such dysfunction include subclinical left ventricular diastolic dysfunction [ 5 , 6 ].…”

“…Abnormal diastolic functionality is an early sign of DCM development [ 5 , 6 ]. The left atrium serves to connect the left ventricle to the pulmonary veins, and as such its size and functionality are closely associated with left ventricular diastolic function, atrial fibrillation, and related complications [ 7 – 9 ].…”