The Present and Future
State-of-the-Art Review
Implications of Underlying Mechanisms for the Recognition and Management of Diabetic Cardiomyopathy

https://doi.org/10.1016/j.jacc.2017.11.019Get rights and content
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Abstract

Heart failure is a complex clinical syndrome, the incidence and prevalence of which is increased in diabetes mellitus, pre-diabetes, and obesity. Although this may arise from underlying coronary artery disease, it often occurs in the absence of significant major epicardial coronary disease, and most commonly manifests as heart failure with preserved ejection fraction. Despite epidemiological evidence linking diabetes to heart failure incidence and outcome, the presence of a distinct primary “diabetic” cardiomyopathy has been difficult to prove, because the link between diabetes and heart failure is confounded by hypertension, microvascular dysfunction, and autonomic neuropathy. Nonetheless, several mechanistic associations at systemic, cardiac, and cellular/molecular levels explain different aspects of myocardial dysfunction, including impaired cardiac relaxation, compliance, and contractility. This review seeks to describe recent advances and limitations pertinent to integrating molecular mechanisms, clinical screening, and potential therapeutic avenues for this condition.

Key Words

diabetes
heart failure
echocardiography
screening

Abbreviations and Acronyms

DCM
diabetic cardiomyopathy
DD
diastolic dysfunction
DM
diabetes mellitus
GLS
global longitudinal strain
HFpEF
heart failure with preserved ejection fraction
O-GlcNAc
β-N-acetylglucosamine
ROS
reactive oxygen species
SGLT2
sodium/glucose cotransporter 2

Cited by (0)

Baker Heart and Diabetes Institute is supported in part by an infrastructure grant from the Victorian Government. Dr. Marwick has received a research grant from General Electric Medical Systems. Drs. Ritchie, Shaw, and Kaye are in receipt of fellowships from the National Health and Medical Research Council, Canberra, Australia. Dr. Shaw has received honoraria for advisory boards, consulting, and/or lectures from AstraZeneca, BGP Products, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, Mylan, Novartis, Novo Nordisk, and Sanofi; and has received support for research programs from AstraZeneca. Drs. Marwick and Richie contributed equally to this work and are joint first authors. Heiko Bugger, MD, served as Guest Editor for this paper.

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