Major Clinical Aspects of Diabetic Cardiomyopathy

Abstract

The cardiovascular complications of type 2 diabetes (T2DM) are contributing considerably to morbidity and mortality worldwide, heart failure (HF) being one of the most frequent. The adverse effect of T2DM on myocardium can develop early, and clinically present as left ventricular (LV) diastolic dysfunction in the absence of other heart disease. The pathophysiology of DC includes the major metabolic features of T2DM such as hyperglycemia, hyperinsulinemia, hyperlipidemia, and the formation of both reactive oxygen species and advanced glycation end-products. There are no pathognomonic diagnostic features of diabetic cardiomyopathy (DC) and no single imaging method exists for the accurate diagnosis. Clinical presentation is mostly mild, and majority of the patients are asymptomatic or with nonspecific complaints. The major hurdles in diagnosing DC are imprecise definition and dissimilar criteria for diagnosis of LV diastolic dysfunction. DC is best defined as myocardial disease in diabetic patients characterized by LV diastolic dysfunction in the absence of hypertension, coronary artery disease or any other cardiac disease. LV diastolic dysfunction is the most important element of diagnosis of DC, best assessed by tissue Doppler echocardiography (E/E' ratio). The prevalence of LV diastolic dysfunction in T2DM demonstrate the wide variations caused by diverse patient selection and heterogeneous criteria for its diagnosis. Patient selection varies in terms of age, duration, stage, and microvascular complications of T2DM. Several clinical correlates were reported as related to DC such as: age, duration of T2DM, parameters of glycoregulation, insulin resistance, and renal function. The treatment of DC should be initiated as early as LV diastolic dysfunction is identified. Various therapeutic options include improving diabetic control with diet, daily physical activity, and reduction in body mass index. Both antiglycaemic (metformin and thiazolidinediones), and cardiovascular drugs (ACE inhibitors, beta blockers and calcium channel blockers) should be used to improve LV diastolic dysfunction. © 2014 by Nova Science Publishers, Inc. All rights reserved.