Diabetic Cardiomyopathy: Insights Into Pathogenesis, Diagnostic Challenges, and Therapeutic Options

Am J Med. 2008 Sep;121(9):748-57. doi: 10.1016/j.amjmed.2008.03.046.

Abstract

Diabetic cardiomyopathy is the presence of myocardial dysfunction in the absence of coronary artery disease and hypertension. Hyperglycemia seems to be central to the pathogenesis of diabetic cardiomyopathy and to trigger a series of maladaptive stimuli that result in myocardial fibrosis and collagen deposition. These processes are thought to be responsible for altered myocardial relaxation characteristics and manifest as diastolic dysfunction on imaging. Sophisticated imaging technologies also have permitted the detection of subtle systolic dysfunction in the diabetic myocardium. In the early stages, these changes appear reversible with tight metabolic control, but as the pathologic processes become organized, the changes are irreversible and contribute to an excess risk of heart failure among diabetic patients independently of common comorbidities, such as coronary artery disease and hypertension. Therapeutic agents specifically targeting processes that lead to these pathophysiologic changes are in the early stages of development. Although glycemic control and early administration of neurohormonal antagonists remain the cornerstones of therapeutic approaches, newer treatment targets are currently being explored.

Publication types

  • Review

MeSH terms

  • Apoptosis / physiology
  • Copper / metabolism
  • Diabetes Complications / diagnosis*
  • Diabetes Complications / drug therapy*
  • Diabetes Complications / etiology
  • Diabetes Complications / physiopathology
  • Echocardiography
  • Fatty Acids, Nonesterified / metabolism
  • Fibrosis / pathology
  • Heart Failure, Diastolic / diagnosis*
  • Heart Failure, Diastolic / drug therapy*
  • Heart Failure, Diastolic / etiology
  • Heart Failure, Diastolic / physiopathology
  • Humans
  • Microcirculation / pathology
  • Myocardium / metabolism
  • Myocardium / pathology
  • Necrosis / pathology
  • Renin-Angiotensin System / physiology
  • Risk Factors
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / drug therapy*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology

Substances

  • Fatty Acids, Nonesterified
  • Copper