Is diabetic cardiomyopathy a specific entity?

Letonja, Mitja; Petrovič, Danijel

doi:10.4330/wjc.v6.i1.8

Cited by 19 publications

(14 citation statements)

References 34 publications

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“…Although experimental ( 19 , 20 , 21 ) and clinical ( 22 , 23 , 24 ) evidence is growing, the existence of a specific diabetic cardiomyopathy is still a matter of debate in this population ( 4 , 25 ). The majority of previous studies ( 10 , 13 , 26 ) involved type 2 diabetic patients, with coexistence of hypertension (38–64%), hypercholesterolemia and obesity, relatively advanced mean age (up to 60 years) and a short diabetes duration (less than 10 years).…”

Section: Discussionmentioning

confidence: 99%

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Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑term follow-up study

Ringlé¹,

Dornhorst²,

Rehman³

et al. 2017

Echo Res Pract

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BackgroundWe sought to assess the long-term evolution of left ventricular (LV) function using two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) for the detection of preclinical diabetic cardiomyopathy, in asymptomatic type 1 diabetic patients, over a 6-year follow-up.Design and methodsSixty-six asymptomatic type 1 diabetic patients with no cardiovascular risk factors were compared to 26 matched healthy controls. Conventional, 2D and 3D-STE were performed at baseline. A subgroup of 14 patients underwent a 6-year follow-up evaluation.ResultsAt baseline, diabetic patients had similar LV ejection fraction (60 vs 61%; P = NS), but impaired longitudinal function, as assessed by 2D-global longitudinal strain (GLS) (−18.9 ± 2 vs −20.5 ± 2; P = 0.0002) and 3D-GLS (−17.5 ± 2 vs −19 ± 2; P = 0.003). At follow-up, diabetic patients had worsened longitudinal function compared to baseline (2D-GLS: −18.4 ± 1 vs −19.2 ± 1; P = 0.03). Global circumferential (GCS) and radial (GRS) strains were unchanged at baseline and during follow-up. Metabolic status did not correlate with GLS, whereas GCS and GRS showed a good correlation, suggestive of a compensatory increase of circumferential and radial functions in advanced stages of the disease – long-term diabetes (GCS: −26 ± 3 vs −23.3 ± 3; P = 0.008) and in the presence of microvascular complications (GRS: 38.8 ± 9 vs 34.3 ± 8; P = 0.04).ConclusionsSubclinical myocardial dysfunction can be detected by 2D and 3D-STE in type 1 diabetic patients, independently of any other cardiovascular risk factors. Diabetic cardiomyopathy progression was suggested by a mild decrease in longitudinal function at the follow-up, but did not extend to a clinical expression of the disease, as no death or over heart failure was reported.

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Section: Discussionmentioning

confidence: 99%

“…Whether diastolic function highlights an early stage of diabetic cardiomyopathy before progressing to more significant systolic dysfunction has been controversial ( 5 , 25 ). The prevalence ranges from 23 to 75% depending on the methods used and populations studied (46% in a study based on the current guidelines) ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑term follow-up study

Ringlé¹,

Dornhorst²,

Rehman³

et al. 2017

Echo Res Pract

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“…Subsequent clinical and epidemiological studies have confirmed these observations [4,5], suggesting that diabetes can damage the cardiac tissue independently of other cardiovascular risk factors. Such associations have provided a credible existence of DCM as a unique clinical entity, independent of hypertension, CAD, left ventricular hypertrophy (LVH), atrial fibrillation, or any other known cardiac diseases, leading to HF, caused by complex relationships between metabolic abnormalities that accompany diabetes and its cellular consequences [6].…”

Section: Introductionmentioning

confidence: 99%

Diabetic Cardiomyopathy: Focus on Oxidative Stress, Mitochondrial Dysfunction and Inflammation

Nunes¹,

Rolo²,

Palmeira³

et al. 2017

Cardiomyopathies - Types and Treatments

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Diabetic cardiomyopathy (DCM) is an independent clinical entity defined as structural and functional changes in the myocardium because of metabolic and cellular abnormalities induced by diabetes, resulting in cardiac failure. Hyperglycemia has been seen as a major cause of DCM due to activation of different mechanisms leading to oxidative stress. Several body of evidence show that distinct pathways of oxygen and nitrogen reactive species formation contribute to myocardial impairment. Abnormal mitochondrial morphology and energetics, evoked by abnormal Ca 2+ handling, metabolic changes and oxidative stress, are observed in DCM, suggesting a pivotal role of mitochondrial dynamics in disease pathogenesis. In addition, insulin resistance compromises myocardial glucose uptake due to cellular depletion of glucose transporter proteins, together with increased myocardial uptake of free fatty acids and augmented triglyceride levels, which cause cardiomyocyte lipotoxicity. Finally, the state of chronic low-grade inflammation, a feature of obese type 2 diabetes, seems to also play a major role in DCM progression, whose mechanisms have been progressively disclosed. In this book chapter, we review the cellular mechanism contributing to DCM development, focusing on oxidative stress, mitochondrial dysfunction and inflammation of cardiomyocytes, as well as on possible therapeutic strategies.

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“…Additionally, insulin resistance and an increase in the mitochondrial in ux of fatty acids predispose to an overproduction of superoxide ions involved in the genesis of hypertrophy, brosis, and left ventricular dysfunction. Furthermore, IR generates reactive oxygen species which are involved in the genesis of LVH and brosis [67].…”

Section: Discussionmentioning

confidence: 99%

Association between insulin resistance and left ventricular hypertrophy in sub-saharan hypertensive black patients with preserved ejection fraction: A case control study

Phanzu

Aliocha

Eleuthère

et al. 2020

Preprint

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Background:Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH).We described the associations between parameters of obesity, fasting insulinemia, HOMAIR with LVH in black patients with essential hypertension.Materials and Methods:A case-control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationship between obesity indices, physical inactivity, parameters of glucose metabolisme and lipid disorders and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analysis, respectively. When differences were observed between LVH and the independent variables, the effect of potential confounders was studied by adjustment in multiple linear regression and in conditional logistic regression in multivariate analysis. The coefficients of determinations (R2), the adjusted ORs and their 95% CI were calculated to determine the association between the LVH and the independent variablesResults:Eighty-eight cases (52 men) were compared to 132 controls (81 men). Nineteen percent of left ventricular mass (LVM) variation (19%) was predicted by age, 31.3% by the duration of hypertension, 44.4% by BMI, 42.5% by WC, 20% by glycemia, 44.8% by insulinemia and 43.7% by HOMAIR. In multiple linear regression analysis, duration of hypertension, Body Mass Index (BMI), insulinemia and HOMAIR explained 68.3% of the variability in the increase in LVM. In the logisitic model obesity multiplied the risk of LVH by 3 (aOR: 2.8, 95% CI (1.06-7.4), p = 0.038), IR by 8 (aOR: 8.4, 95: (3.7-15.7), p <0.001).Conclusion:Obesity and IR appear to be the main predictors of LVH. The comprehensive management of cardiovascular risk factors should be emphasized with particular attention to obesity and insulin resistance. A prospective black sub-saharan population based study with serial imaging remain essential to better understand subclinical LV deterioration over time and to confirm the role of insulin resistance in black sub-saharan hypertensives.

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Is diabetic cardiomyopathy a specific entity?

Cited by 19 publications

References 34 publications

Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑term follow-up study

Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑term follow-up study

Diabetic Cardiomyopathy: Focus on Oxidative Stress, Mitochondrial Dysfunction and Inflammation

Association between insulin resistance and left ventricular hypertrophy in sub-saharan hypertensive black patients with preserved ejection fraction: A case control study

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