Diabetic cardiomyopathy

Congestive heart failure (CHF) represents a common cardiovascular complication of diabetes mellitus associated with increased morbidity and mortality. Although it is usually due to the development of ischemic or hypertensive heart disease, accumulating evidence supports the notion that diabetic cardiomyopathy ( DC) exists as a distinct clinical entity, separate from other forms of cardiomyopathy, and that it contributes considerably to the adverse prognosis of diabetic patients. The pathophysiologic mechanisms responsible for the development of DC include the abnormal utilization of the metabolic substrate by the diabetic heart, insulin resistance, small vessel disease of the heart and autonomic cardiac neuropathy. The end result is myocardial cell injury, reactive hypertrophy, interstitial fibrosis and gradual development of DC. The myocardium in DC is vulnerable to ischemic insults as well as to the effects of coexistent hypertension, as the progressive activation of neurohumoral pathways leads to further diminution of cardiac function and earlier development of CHF. Of paramount importance in the management of DC is its recognition in the very early stages, by the use of echocardiography, and especially by novel echocardiographic techniques. The optimal primary and secondary management of the syndrome of DC is based on knowledge and adoption of the recent therapeutic guidelines, with collaboration between general practitioners, diabeticians and cardiologists with sensitivity in the recognition, diagnosis and management of this special clinical entity.