Diabetic cardiomyopathy: pathophysiology and clinical features

Abstract

Since diabetic cardiomyopathy was first reported four decades ago, substantial information on its pathogenesis and clinical features has accumulated. In the heart, diabetes enhances fatty acid metabolism, suppresses glucose oxidation, and modifies intracellular signaling, leading to impairments in multiple steps of excitation–contraction coupling, inefficient energy production, and increased susceptibility to ischemia/reperfusion injury. Loss of normal microvessels and remodeling of the extracellular matrix are also involved in contractile dysfunction of diabetic hearts. Use of sensitive echocardiographic techniques (tissue Doppler imaging and strain rate imaging) and magnetic resonance spectroscopy enables detection of diabetic cardiomyopathy at an early stage, and a combination of the modalities allows differentiation of this type of cardiomyopathy from other organic heart diseases. Circumstantial evidence to date indicates that diabetic cardiomyopathy is a common but frequently unrecognized pathological process in asymptomatic diabetic patients. However, a strategy for prevention or treatment of diabetic cardiomyopathy to improve its prognosis has not yet been established. Here, we review both basic and clinical studies on diabetic cardiomyopathy and summarize problems remaining to be solved for improving management of this type of cardiomyopathy.

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

“…Overall, 30 consecutive children and adolescents with type 1 diabetes (age range [5][6][7][8][9][10][11][12][13][14][15][16][17] years, male: 53%) were recruited at our pediatric endocrinology department and enrolled in this prospective cohort. Among children with diabetes, HBA 1c ranged from 6.8% to 12.7% , 63% of the patients with diabetes patients had HBA 1C > 8 % and mean diabetes duration was 5.1 ± 3.1 years.…”

“…Chronic hyperglycemia induces complex metabolic disturbances in cardiomyocytes, leading to morphological and functional abnormalities of the myocardium, grouped under the term "diabetic cardiomyopathy" [5] . Diabetic cardiomyopathy is characterized by the presence of extensive myocardial fibrosis, myocyte hypertrophy, increased oxidative stress, and microangiopathy [6] . While frequent, to date, a specific strategy for early detection or treatment of diabetic cardiomyopathy to improve its prognosis has not yet been established [6] .…”

“…Diabetic cardiomyopathy is characterized by the presence of extensive myocardial fibrosis, myocyte hypertrophy, increased oxidative stress, and microangiopathy [6] . While frequent, to date, a specific strategy for early detection or treatment of diabetic cardiomyopathy to improve its prognosis has not yet been established [6] . In adults, echocardiographic or magnetic resonance studies have shown that diabetes led to eccentric left ventricular (LV) hypertrophy with alterations of the diastolic and systolic myocardial function [7,8] .…”

Heart Failure as a Comorbidity of Diabetes: Role of Dipeptidyl Peptidase 4

“…The myocardium possesses an insulin receptor that determines its innate insulin signaling pathway connecting to metabolic 31) and mitochondrial remodeling [31][32][33] . It gains consensus that an abnormal excess of insulin signaling exerts vicious effects on the cardiovascular sys-induced impaired Ca 2 homeostasis 61) .…”

Intravenous administration of bone marrow-derived multipotent mesenchymal stromal cells has a neutral effect on obesity-induced diabetic cardiomyopathy

“…However, it has been reported that lipid accumulation of cardiomyocytes changes their energy metabolism, increasing oxidative stress, impairing calcium handling and mitochondrial dysfunction, which promote cardiomyocyte death and interstitial fi brosis (Boudina and Abel, 2010). At present, clinical treatments for diabetic cardiomyopathy are aimed at delaying its progression, mainly by improving metabolic alterations using hypoglycemic agents, and cardiac performance using β-blockers and angiotensin-converting enzyme inhibitors (Miki et al, 2013). Therefore, new therapies intended to reverse heart failure in obese individuals would have a signifi cant impact on the health system (Bernardi et al, 2012).…”