Diagnostic approaches for diabetic cardiomyopathy

Abstract

Diabetic cardiomyopathy (DCM) is a cardiac dysfunction which affects approximately 12% of diabetic patients, leading to overt heart failure and death. However, there is not an efficient and specific methodology for DCM diagnosis, possibly because molecular mechanisms are not fully elucidated, and it remains asymptomatic for many years. Also, DCM frequently coexists with other comorbidities such as hypertension, obesity, dyslipidemia, and vasculopathies. Thus, human DCM is not specifically identified after heart failure is established. In this sense, echocardiography has been traditionally considered the gold standard imaging test to evaluate the presence of cardiac dysfunction, although other techniques may cover earlier DCM detection by quantification of altered myocardial metabolism and strain. In this sense, Phase-Magnetic Resonance Imaging and 2D/3D-Speckle Tracking Echocardiography may potentially diagnose and stratify diabetic patients. Additionally, this information could be completed with a quantification of specific plasma biomarkers related to related to initial stages of the disease. Cardiotrophin-1, activin A, insulin-like growth factor binding protein-7 (IGFBP-7) and Heart fatty-acid binding protein have demonstrated a stable positive correlation with cardiac hypertrophy, contractibility and steatosis responses. Thus, we suggest a combination of minimally-invasive diagnosis tools for human DCM recognition based on imaging techniques and measurements of related plasma biomarkers.

Diabetic cardiomyopathy

“…There are a wide variety of mechanisms proposed to be involved in the process underlying diabetic cardiomyopathy (figures 2 and 3)21 including epicardial and microvascular coronary artery disease, diabetes-induced myocardial disease (independent of other cardiovascular processes) and diabetic autonomic neuropathy.…”

“…21 In patients with acute heart failure, levels of many biomarkers have been found to be higher in cohorts of patients with diabetes compared with control subjects 79. Whether they are indicators of diabetic cardiomyopathy or are elevated because of the various cardiovascular processes that occur in patients with diabetes is uncertain.…”

Long noncoding RNAs: A new player in the prevention and treatment of diabetic cardiomyopathy?

“…Diabetic cardiomyopathy affects approximately 12% diabetic patients, disturbing almost 22% subjects older than 64 years, which represent between 36 and 66 million of diabetic people, respectively leading to overt heart failure and death . Although there are different technologies available today, there is no gold standard for DCM diagnosis in clinical practice, possibly because molecular mechanisms are not fully elucidated . Indeed, DCM is often detected by recognizing systolic dysfunction in advanced stages of heart failure that has already been established .…”

“…Indeed, DCM is often detected by recognizing systolic dysfunction in advanced stages of heart failure that has already been established . Cardiac catheterization and endomyocardial biopsy sampling are precise and generally accepted ways for early diastolic dysfunction diagnosing, but their use is limited to the research environment because of the high risk they pose . Magnetic resonance imaging shows higher repeatability and precision than that in echocardiography and can be used for measuring myocardial steatosis, left ventricular mass, and diastolic dysfunction over and above providing data of myocardial fibrosis.…”

Shengmai San Alleviates Diabetic Cardiomyopathy Through Improvement of Mitochondrial Lipid Metabolic Disorder

“…Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular disease [1]. Diabetic cardiomyopathy (DCM), a leading cause of morbidity and mortality, is a diabetes-related complication characterized by left ventricular (LV) hypertrophy, myocardial fibrosis, and compromised myocardial function [2,3].…”