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

Ashish Aneja, W. H.Wilson Tang, Sameer Bansilal, Mario J. Garcia, Michael E. Farkouh

Research output: Contribution to journalReview article

325 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)748-757
Number of pages10
JournalAmerican Journal of Medicine
Volume121
Issue number9
DOIs
StatePublished - Sep 1 2008

Keywords

  • Diabetes Mellitus
  • Diastolic dysfunction
  • Heart Failure
  • Pathophysiology
  • Treatment

ASJC Scopus subject areas

  • Medicine(all)

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