ReviewDiabetic Cardiomyopathy: Insights into Pathogenesis, Diagnostic Challenges, and Therapeutic Options
Section snippets
Pathophysiologic Mechanisms of Diabetic Cardiomyopathy
A clear understanding of the precise pathophysiologic mechanisms of diabetic cardiomyopathy is still lacking. However, several pathophysiologic mechanisms have been proposed to explain the structural and functional changes associated with diabetic cardiomyopathy (Figure 1). These processes are not mutually exclusive and likely act synergistically to develop diabetic cardiomyopathy. Hyperglycemia is considered to be a central driver in the pathophysiology of diabetic cardiomyopathy because it
Diagnosing Diabetic Cardiomyopathy
There are 2 important components in the clinical diagnosis of diabetic cardiomyopathy: the detection of myocardial abnormalities and the exclusion of other contributory causes of cardiomyopathy. An important challenge in the clinical diagnosis of diabetic cardiomyopathy has been the lack of any pathognomonic histologic changes or imaging characteristics associated with the diagnosis. Endomyocardial biopsies are not indicated because of their invasiveness, unless circumstances to suspect other
Glycemic Control
The prevention and treatment of diabetic cardiomyopathy are clinically relevant because of its role in the pathogenesis of heart failure. Although the effect of glycemic control on diabetic cardiomyopathy has been studied in only a limited fashion, evidence suggests that good glycemic control is beneficial, at least in the early stages of myocardial dysfunction.61, 62, 63 Evidence also suggests that diabetic cardiomyopathy does not develop in patients with tightly controlled type 1 diabetes,
Conclusions
Diabetic cardiomyopathy has progressed from a nebulous concept to concrete reality during the last 3 decades. Multiple pathophysiologic mechanisms have been proposed to explain this entity, but hyperglycemia seems to be the central mechanism triggering the processes that lead to the ultimate pathologic changes of myocardial hypertrophy, fibrosis, and collagen deposition. From epidemiologic studies, the natural history of diabetic cardiomyopathy seems to start with impaired glucose tolerance and
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