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Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes

European heart journal, 2015-07, Vol.36 (27), p.1718-1727 [Peer Reviewed Journal]

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com. ;ISSN: 0195-668X ;EISSN: 1522-9645 ;DOI: 10.1093/eurheartj/ehv134 ;PMID: 25888006

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Title:
Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes
Author: Seferović, Petar M ; Paulus, Walter J
Subjects: Autoimmunity - physiology ; Cardiomyopathy, Dilated - diagnosis ; Cardiomyopathy, Dilated - etiology ; Cardiomyopathy, Dilated - therapy ; Cardiomyopathy, Restrictive - diagnosis ; Cardiomyopathy, Restrictive - etiology ; Cardiomyopathy, Restrictive - therapy ; Diabetic Cardiomyopathies - diagnosis ; Diabetic Cardiomyopathies - etiology ; Diabetic Cardiomyopathies - therapy ; Glycation End Products, Advanced - metabolism ; Heart Failure - diagnosis ; Heart Failure - etiology ; Heart Failure - therapy ; Humans ; Hyperglycemia - etiology ; Hypoglycemic Agents - therapeutic use ; Insulin Resistance - physiology ; Phenotype ; Risk Reduction Behavior ; Ventricular Dysfunction - diagnosis ; Ventricular Dysfunction - etiology ; Ventricular Dysfunction - therapy
Is Part Of: European heart journal, 2015-07, Vol.36 (27), p.1718-1727
Description: Diabetes mellitus-related cardiomyopathy (DMCMP) was originally described as a dilated phenotype with eccentric left ventricular (LV) remodelling and systolic LV dysfunction. Recently however, clinical studies on DMCMP mainly describe a restrictive phenotype with concentric LV remodelling and diastolic LV dysfunction. Both phenotypes are not successive stages of DMCMP but evolve independently to respectively heart failure with preserved left ventricular ejection fraction (HFPEF) or reduced left ventricular ejection fraction (HFREF). Phenotype-specific pathophysiological mechanisms were recently proposed for LV remodelling and dysfunction in HFPEF and HFREF consisting of coronary microvascular endothelial dysfunction in HFPEF and cardiomyocyte cell death in HFREF. A similar preferential involvement of endothelial or cardiomyocyte cell compartments explains DMCMP development into distinct restrictive/HFPEF or dilated/HFREF phenotypes. Diabetes mellitus (DM)-related metabolic derangements such as hyperglycaemia, lipotoxicity, and hyperinsulinaemia favour development of DMCMP with restrictive/HFPEF phenotype, which is more prevalent in obese type 2 DM patients. In contrast, autoimmunity predisposes to a dilated/HFREF phenotype, which manifests itself more in autoimmune-prone type 1 DM patients. Finally, coronary microvascular rarefaction and advanced glycation end-products deposition are relevant to both phenotypes. Diagnosis of DMCMP requires impaired glucose metabolism and exclusion of coronary, valvular, hypertensive, or congenital heart disease and of viral, toxic, familial, or infiltrative cardiomyopathy. In addition, diagnosis of DMCMP with restrictive/HFPEF phenotype requires normal systolic LV function and diastolic LV dysfunction, whereas diagnosis of DMCMP with dilated/HFREF phenotype requires systolic LV dysfunction. Treatment of DMCMP with restrictive/HFPEF phenotype is limited to diuretics and lifestyle modification, whereas DMCMP with dilated/HFREF phenotype is treated in accordance to HF guidelines.
Publisher: England
Language: English
Identifier: ISSN: 0195-668X
EISSN: 1522-9645
DOI: 10.1093/eurheartj/ehv134
PMID: 25888006
Source: GFMER Free Medical Journals
MEDLINE
Alma/SFX Local Collection

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Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com. ;ISSN: 0195-668X ;EISSN: 1522-9645 ;DOI: 10.1093/eurheartj/ehv134 ;PMID: 25888006

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