Diabetic myocardial disease: pathophysiology, early diagnosis and therapeutic options

Diabetic Cardiomyopathy: Cardiac Changes, Pathophysiological Mechanisms, Biologic Markers, and the Available Therapeutic Armamentarium

“…In both human and animal models of type 1 and type 2 DM, systolic functional disorders have been shown to be associated with a reduction in ejection fraction (EF), fractional shortening (FS), and cardiac output (CO) (Mihm et al, 2001;Mildenberger et al, 1984;Mytas et al, 2009 ). In vivo animal studies using invasive catheterization have revealed loaddependent and -independent indices of systolic dysfunction in diabetic hearts (Hamblin et …”

“…Although no single diagnostic test for diabetic cardiomyopathy exists, the use of different imaging modalities (echocardiography, cardiac MRI) makes it possible to detect the phenotypic features of this condition (Asghar et al, 2009). Echocardiography is the diagnostic method that can achieve early detection of diabetic cardiomyopathy since it can detect structural myocardial changes (LVH and increased cardiac mass) in addition to evaluation of diastolic and systolic heart dysfunction (Mytas et al, 2009). As a result, echocardiography based methods currently stand as the preferred diagnostic approach for diabetic cardiomyopathy in clinical practice (Maya & Villarreal, 2010 Although brain natriuretic peptide (BNP), a hormone secreted by the ventricles of the heart in response to ventricular volume and pressure overload, is both sensitive and specific for HF, research has shown that BNP is of limited diagnostic utility for diagnosing diabetic cardiomyopathy (Fang et al, 2005;Valle et al, 2006).…”

“…This is due in part to the fact that BNP cannot reliably distinguish between systolic and diastolic HF, which limits its use in diabetic cardiomyopathy (Asghar et al, 2009;Fang et al, 2005;Maisel et al, 2003). Furthermore, the triggers for BNP secretion (increased intraventricular volume and pressure) does not occur in patients with subclinical, asymptomatic diabetic cardiomyopathy (Mytas et al, 2009;Stevanovic et al, 2006). In light of these findings, it is recommended that BNP not be used in isolation to diagnose or exclude diabetic cardiomyopathy (Fang et al, 2005;Kamalesh, 2007).…”

Diastolic function of the right ventricle is impaired in experimental type 2 diabetic rat models

“…Diabetes-induced myocardial diseases are the primary causes of morbidity and mortality in patients with diabetes mellitus (DM) (1). In 1972, Rubler et al described a special type of diabetes-induced myocardial disease as the development of heart failure in diabetic subjects with the absence of ischemic, hypertension, and valvular heart disease, which was called diabetic cardiomyopathy (DCM) (2).…”

One of the causes of secondary cardiyomyopathies: Diabetic cardiomyopathy

“…Cardiovascular complications, including diabetic cardiomyopathy, are major causes of morbidity and mortality in diabetic patients [3]. Once heart failure is clinically manifested, it has an exceedingly high mortality rate-four to eight times greater than the general population [4].…”