Background: Diabetic Cardiomyopathy (DC) has been defined as a distinct entity
characterized by the presence of diastolic or systolic cardiac dysfunction in a diabetic
patient in the absence of other causes for Cardiomyopathy, such as coronary artery disease
(CAD), hypertension (HTN), or valvular heart disease. Diabetes affects every organ
in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic
population. Diabetes-related heart disease occurs in the form of coronary artery disease
(CAD), cardiac autonomic neuropathy or DC. The prevalence of cardiac failure is
high in the diabetic population and DC is a common, but underestimated cause of heart
failure in diabetes. The strong association between diabetes and heart failure has fueled
intense human and animal research aimed at identifying the mechanisms underlying diabetic
myocardial disease. Despite significant progress made, the precise pathogenesis of
diabetic Cardiomyopathy is yet to be clearly defined. Hyperglycemia, dyslipidemia and
inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen
species which are in turn involved.
Methods: We have reviewed the up-to-date scientific literature addressing these issues.
Results: The myocardial interstitium undergoes alterations resulting in abnormal contractile
function noted in DC. In the early stages of the disease, diastolic dysfunction is the
only abnormality, but systolic dysfunction supervenes in the later stages with impaired
left ventricular ejection fraction. Transmitral Doppler echocardiography is usually used to
assess diastolic dysfunction, but tissue Doppler Imaging and Cardiac Magnetic Resonance
Imaging are being increasingly used for early detection of DC. Diabetic patients with microvascular
complications show the strongest association between diabetes and Cardiomyopathy,
an association that parallels the duration and severity of hyperglycemia.
Conclusion: The management of DC involves improvement in lifestyle, control of glucose
and lipid abnormalities, together with treatment of hypertension and CAD, if present.