Diabetic cardiomyopathy

Authors: J. Dúbrava
Authors‘ workplace: Oddelenie funkčnej diagnostiky FNsP sv. Cyrila a Metoda, Bratislava, Slovenská republika, vedúci prim. MUDr. Juraj Dúbrava, Ph. D.
Published in: Vnitř Lék 2005; 51(3): 314-319
Category: Reviews


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.

Key words:
diabetic cardiomyopathy – heart failure – echocardiography – heart rate variability – apoptosis


1. Bělobrádková J, Filipenský B. Srdce diabetika. Vnitř Lék 2003; 49(12): 921–926.

2. Cai L, Kang YJ. Oxidative stress and diabetic cardiomyopathy: a brief review. Cardiovasc Toxicol 2001; 1(3): 181–193.

3. Cohen A. Diabetic cardiomyopathy. Arch Mal Coeur Vaiss 1995; 8(4): 479–486.

4. Codinach Huix P, Freixa Pamias R. Diabetic cardiomyopathy: concept, heart function and pathogenesis. An Med Interna 2002; 19(6): 313–320.

5. Di Bello V, Giampietro O, Matteuci E et al. Ultrasonic tissue characterization analysis in type 1 diabetes: a very early index of diabetic cardiomyopathy? G Ital Cardiol 1998; 28(10): 1128–1137.

6. Fang ZY, Najos Valencia O, Leano R et al. Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine. J Am Coll Cardiol 2003; 42(3): 446–453.

7. Fiordaliso F, Leri A, Cesselli D et al. Hyperglycemia activates p53 and p53-regulated genes leading to myocyte cell death. Diabetes 2001; 50(10): 2363–2375.

8. Francis GS. Diabetic cardiomyopathy: fact or fiction? Heart 2001; 85(3): 247–248.

9. Frustaci A, Kajstura J, Chimenti C et al. Myocardial cell death in human diabetes. Circ Res 2000; 87(12): 1123–1132.

10. Galderisi M, Anderson KM, Wilson PW et al. Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy (the Framingham Heart Study). Am J Cardiol 1991; 68(1): 85–89.

11. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996; 17(3): 354–381.

12. Charvát J, Chlumský J, Vaněček T et al. Porovnání klinických a echokardiografických změn u diabetiků 2. typu a nediabetiků s klidovou dušností na podkladě levostranné srdeční slabosti. Vnitř Lék 2002; 48(10): 952–955.

13. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34(1): 29–34.

14. Kvapil M. Hypertenze a diabetes - současné pohledy na speciální otázky. Vnitř Lék 2003; 49(12): 935–937.

15. Nesto RW, Libby P. Diabetes mellitus and the cardiovascular system. In: Braunwald E, Zipes DP, Libby P. Heart Disease. A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: WB Saunders: 2001: 2133–2150.

16. Picano E. Diabetic cardiomyopathy. The importance of being the earliest. J Am Coll Cardiol 2003; 42(3): 454–457.

17. Poirier P, Bogaty P, Garneau C et al. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes – importance of maneuvers in echocardiograhic screening for preclinical diabetic cardiomyopathy. Diabetes Care 2001; 24(1): 5–10.

18. Poirier P, Bogaty P, Philippon F et al. Preclinical diabetic cardiomyopathy: relation of left ventricular diastolic dysfunction to cardiac autonomic neuropathy in men with uncomplicated wellcontrolled type 2 diabetes. Metabolism 2003; 52(8): 1056–1061.

19. Raev DC. Which left ventricular function is impaired earlier in the evolution of diabetic cardiomyopathy? An echocardiographic study of young type I diabetic patients. Diabetes Care 1994; 17(7): 633–639.

20. Richardson P, McKenna W, Bristow M et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology task force on the definition and classification of cardiomyopathies. Circulation 1996; 93(5): 841–842.

21. Rubler S, Dlugash J, Yuceoglu YZ et al. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972; 30(6): 595–602.

22. Schannwell CM, Schoebel FC, Heggen S et al. Early decrease in diastolic function in young type I diabetic patients as an initial manifestation of diabetic cardiomyopathy. Z Kardiol 1999; 88(5): 338–346.

23. Spector KS. Diabetic cardiomyopathy. Clin Cardiol 1998; 21(12): 885-887.

24. Stoddard MF. Echocardiography in the evaluation of cardiac disease due to endocrinopathies, renal disease, obesity, and nutritional deficiencies. In: Otto CM. The practice of clinical echocardiography. Philadelphia: WB Saunders 2002: 779–796.

25. Špinar J, Vítovec J. Diabetes mellitus a chronické srdeční selhání. Vnitř Lék 2003; 49(12): 927–934.

26. Yusuf S, Pfeffer MA, Swedberg K et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003; 362: 777–781.

27. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342(3): 145–153.

28. Zachar A. Analysis of left ventricular function using 2-dimensional and pulsed Doppler echocardiography in type I diabetes. Bratisl Lek Listy 1990; 91(7): 533–538.

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