Cardiologia Croatica, Vol. 8 No. 12, 2013.
Review article
Diabetic cardiomyopathy
Jasna Čerkez Habek
; Sveti Duh University Hospital, Zagreb, Croatia
Jozica Šikić
; Sveti Duh University Hospital, Zagreb, Croatia
Abstract
Diabetic cardiomyopathy, coronary heart disease (CHD) and autonomic neuropathy are the diseases that increase morbidity and mortality in patients with diabetes mellitus. Diabetic cardiomyopathy is characterized by asymptomatic, progressive changes in the structure, and also in the myocardial function that lead to myocardial remodeling, and are not related to CHD, hypertension or valvular pathology. The etiology of these changes is multifactorial and is the consequence of metabolic imbalance that is primarily related to long-term hyperglycemia. Unfortunately, diabetic cardiomyopathy, despite its significance often remains an unrecognized complication of diabetes that patients suffer from for several years that however, greatly increases mortality. The clinical symptoms may vary from subclinical ventricular dysfunction to advanced clinical symptoms of heart failure. Patients with advanced diabetic cardiomyopathy have two to five time higher risk of heart failure. Echocardiography is the standard in detecting cardiomyopathies, in the initial stage of the disease there is an impairment of the diastolic function of a different degree, and the reduction of systolic left ventricular function is verified only in the end-stage of cardiomyopathy. Rarely, the diagnosis is made by using magnetic resonance imaging, and reserchers have found new biomarkers that would facilitate the diagnostics in asymptomatic patients. The treatment of diabetic cardiomyopathy involves changes in lifestyle, better glycemic control, lipid profile and hypertension accompanied by regular physical activity, whereas the therapy of heart failure does not differ from the therapy administered to the patients without diabetes. Unfortunately, the myocardial structural and morphological changes start already in the pre-diabetic stage, therefore, the new trials are expected to identify biomarkers that can detect asymptomatic patients thereby finding a strategy that would make the above changes reversible.
Keywords
diabetic cardiomyopathy; heart failure; risk factors; pathophysiological mechanisms; prevention
Hrčak ID:
112597
URI
Publication date:
17.12.2013.
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