Title:Present Insights on Cardiomyopathy in Diabetic Patients
Volume: 12
Issue: 4
Author(s): João Soares Felício, Camila Cavalcante Koury, Carolina Tavares Carvalho, João Felício Abrahão Neto, Karem Barbosa Miléo, Thaís Pontes Arbage, Denisson Dias Silva, Alana Ferreira de Oliveira, Amanda Soares Peixoto, Antônio Bentes Figueiredo, Ândrea Kely Campos Ribeiro dos Santos, Elizabeth Sumi Yamada and Maria Teresa Zanella
Affiliation:
Keywords:
Diabetic cardiomyopathy, diabetes mellitus, left ventricular hypertrophy, left ventricular dysfunction, ambulatorial
blood pressure measurement, diabetic autonomic neuropathy.
Abstract: The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely
to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic
neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms
of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of
these underlying mechanisms, focusing in the clinical features and management. The novelty of this
review is the role of CAN and reduction of blood pressure descent during sleep in the development
of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic
dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation
of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation
of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede
the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients
with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium
abnormalities. Considering that DCM could be asymptomatic for a long period and progress
to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities
are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type
2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN
tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities
in these tests in the attempt of reducing cardiovascular morbidity and mortality.
