Diabetic cardiomyopathy: Pathophysiological and clinical aspects

Several studies have suggested the existence of a diabetic cardiomyopathy i ndependent of coronary vascular sclerosis and hypertension. The condition i s often without symptoms and/or with slight signs of anatomical and functio nal abnormalities. The pathogenetic mechanisms involved are various and not all completely understood. Metabolic abnormalities in glucose transport an d lipid metabolism, alterated calcium and potassium homeostasis, microangio pathy with microaneurisms and microthrombi, cardiomyocytes hyperthrophy, st ructural collagen alterations, interstitial and perivascular fibrosis and d eficit in serin-protease inhibitors have been described as frequent and par tly specific features of diabetic cardiomyopathy. Echocardiography has demo nstrated the presence of a diastolic dysfunction, as the earliest sign of d iabetic cardiomyopathy, Slight left ventricular hypertrophy with impaired l eft ventricular filling and relaxation has been described. Systolic functio n is normal or even increased at rest, but usually decreased during heavy e xercise, In conclusion, according to these findings, diabetic cardiomyopath y seems to be a rattler early complication, although frequently latent, but independent of other clinical conditions involving the heart in diabetes. (C) 1998, Editrice Kurtis.