Vnitr Lek 2005, 51(3):314-319

Diabetic cardiomyopathy

J. Dúbrava

Oddelenie funkčnej diagnostiky FNsP sv. Cyrila a Metoda, Bratislava, Slovenská republika, vedúci prim. MUDr. Juraj Dúbrava, Ph.D.

Diabetic cardiomyopathy (CMP) is defined as heart muscle disease specifically due to diabetes mellitus, distinct from coronary atherosclerosis and arterial hypertension, characterized by systolic and/or diastolic left ventricular (LV) dysfunction. Diagnosis of diabetic CMP requires exclusion of all other potential causes of LV dysfunction. Its pathogenesis is not definitively known. According to the current knowledge the decisive factor is a loss of cardiomyocytes due to increased apoptosis. Dominant pathological findings are interstitial fibrosis with collagen accumulation and PAS positivity and arteriolar hyalinization. Neither evidence of large-vessel coronary disease nor abnormalities in myocardial capillary basal lamina are present. Echocardiographic findings are not specific. Sophisticated techniques (tissue characterization, tissue Doppler imaging, LAD Doppler flowmetry) can detect subclinical diabetic CMP long before than LV dysfunction can be detected by conventional echocardiography. Diastolic/systolic LV dysfunction is seen approximately 8/18 years after onset of type I diabetes. A promising screening technique for diabetic CMP could be the analysis of heart rate variability. Tight glycemic control could be a strategy to prevent CMP, along with pharmacologic treatment - angiotensin converting enzyme inhibitors, selective blockers of angiotensin II type 1 receptors, or aldosterone antagonists at low non-diuretic doses. Specific therapy of diabetic CMP is currently not known, because advanced structural myocardial alterations are hardly reversible with any form of the available treatment.

Keywords: diabetic cardiomyopathy; heart failure; echocardiography; heart rate variability; apoptosis

Received: March 1, 2004; Accepted: May 3, 2004; Published: March 1, 2005  Show citation