Cardiometabolic Care: Assessing Patients with Diabetes Mellitus with No Overt Cardiovascular Disease in the Light of Heart Failure Development Risk

Abstract

The mechanisms leading to the development of heart failure (HF) in diabetes mellitus (DM) patients are multifactorial. Assessing the risk of HF development in patients with DM is valuable not only for the identification of a high-risk subgroup, but also equally important for defining low-risk subpopulations. Nowadays, DM and HF have been recognized as sharing similar metabolic pathways. Moreover, the clinical manifestation of HF can be independent of LVEF classification. Consequently, approaching HF should be through structural, hemodynamic and functional evaluation. Thus, both imaging parameters and biomarkers are important tools for the recognition of diabetic patients at risk of HF manifestation and HF phenotypes, and arrhythmogenic risk, and eventually for prognosis, aiming to improve patients’ outcomes utilizing drugs and non-pharmaceutical cardioprotective tools such as diet modification.

A Comparative Change in Left Ventricular Mass Index on Echocardiography in Hypertensive Diabetic and Non-Diabetic Patients Taking Candesartan

“…The most significant finding of another study was that a serial decrease in LV mass in uncomplicated individuals with critical hypertension has a good prognostic value by foretelling a lower probability of developing cardiovascular disease in the future 15 . 8,16 The leading cause of overall diabetes morbidity and mortality remains to be heart disease, which develops eventually in the majority of individuals with DM. 17 Because LVH is a warning sign and a separate risk factor for sudden death, ventricular dysrhythmia, myocardial ischemia, coronary heart disease, and heart failure, increased LVM may be a factor in the increased cardiovascular risk.…”

“…6 By subtracting the volume of the left ventricular cavity from the volume encircled by the equivalent epicardium to obtain myocardial volume, and then multiplying by myocardial density, the left ventricular mass is quantified by echocardiography. 8 Although having severe limitations due to the requirement for prolate ellipsoid-based cardiac geometry assumptions, the linear approach for evaluating LV mass has historically been the reference standard. 9 Thus, using machine learning (ML) or Artificial intelligence (AI) in 3D has the huge potential to completely transform how we identify and measure left ventricular mass.…”