Current Diabetes Reports

, Volume 6, Issue 1, pp 36–41 | Cite as

The diabetic myocardium

  • Thomas H. Marwick


Heart failure and diabetes mellitus are frequently associated, with diabetes potentiating the development of heart failure after other myocardial insults. This review documents the evidence in support of a specific primary myocardial disease in diabetes. The strongest clinical evidence relates to the detection of otherwise unexplained diastolic dysfunction in apparently healthy diabetic subjects, but recent studies with sensitive echocardiographic markers have shown systolic disturbances as well. The mechanism of this myocardial disease is multifactorial, with contributions from metabolic effects on the myocyte, structural changes in the myocardium and interstitium, autonomic neuropathy, and perhaps coronary vascular disease. The common pathway appears to be related to glycemic control and new evidence suggests better metabolic control to be beneficial, as well as angiotensinconverting enzyme inhibition and cross-link breakers.


Glycemic Control Diastolic Dysfunction Diabetic Subject Autonomic Neuropathy Diabetic Cardiomyopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Fisher M: Diabetes and atherogenesis. Heart 2004, 90:336–340. Excellent recent review of the mechanisms of diabetic involvement in atherogenesis.PubMedCrossRefGoogle Scholar
  2. 2.
    Bell DS: Heart failure: the frequent, forgotten, and often fatal complication of diabetes. Diabetes Care 2003, 26:2433–2441.PubMedCrossRefGoogle Scholar
  3. 3.
    Rubler S, Dlugash J, Yuceoglu YZ, et al.: New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972, 30:595–602.PubMedCrossRefGoogle Scholar
  4. 4.
    Coughlin SS, Pearle DL, Baughman KL, et al.: Diabetes mellitus and risk of idiopathic dilated cardiomyopathy. The Washington, DC Dilated Cardiomyopathy Study. Ann Epidemiol 1994, 4:67–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Redfield MM, Jacobsen SJ, Burnett JC Jr, et al.: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003, 289:194–202.PubMedCrossRefGoogle Scholar
  6. 6.
    Kannel WB, McGee D: Diabetes and cardiovascular disease: the Framingham study. JAMA 1979, 241:2035–2038.PubMedCrossRefGoogle Scholar
  7. 7.
    de Groote P, Lamblin N, Mouquet F, et al.: Impact of diabetes mellitus on long-term survival in patients with congestive heart failure. Eur Heart J 2004, 25:656–662.PubMedCrossRefGoogle Scholar
  8. 8.
    Fang ZY, Sharman J, Prins JB, Marwick TH: Determinants of exercise capacity in patients with type 2 diabetes. Diabetes Care 2005, 28:1643–1648.PubMedCrossRefGoogle Scholar
  9. 9.
    Hunt SA, Abraham WT, Chin M, et al.: ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005, 46:1116–1143.CrossRefGoogle Scholar
  10. 10.
    Davies M, Hobbs F, Davis R, et al.: Prevalence of leftventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. Lancet 2001, 358:439–444.PubMedCrossRefGoogle Scholar
  11. 11.
    McCullough PA, Nowak RM, McCord J, et al.: B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 2002, 106:416–422.PubMedCrossRefGoogle Scholar
  12. 12.
    Fang ZY, Schull-Meade R, Leano R, et al.: Screening for heart disease in diabetic subjects. Am Heart J 2005, 149:349–354.PubMedCrossRefGoogle Scholar
  13. 13.
    Zabalgoitia M, Ismaeil MF, Anderson L, Maklady FA: Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus. Am J Cardiol 2001, 87:320–323. Important paper illustrating the role of echocardiographic steps to identify pseudonormal flow on the prevalence of diastolic dysfunction in patients with diabetes mellitus.PubMedCrossRefGoogle Scholar
  14. 14.
    Boyer JK, Thanigaraj S, Schechtman KB, Perez JE: Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004, 93:870–875.PubMedCrossRefGoogle Scholar
  15. 15.
    Trost SU, Belke DD, Bluhm WF, et al.: Overexpression of the sarcoplasmic reticulum Ca(2+)-ATPase improves myocardial contractility in diabetic cardiomyopathy. Diabetes 2002, 51:1166–1171.PubMedCrossRefGoogle Scholar
  16. 16.
    Flarsheim CE, Grupp IL, Matlib MA: Mitochondrial dysfunction accompanies diastolic dysfunction in diabetic rat heart. Am J Physiol 1996, 271:H192-H202.PubMedGoogle Scholar
  17. 17.
    Yu CM, Lin H, Yang H, et al.: Progression of systolic abnormalities in patients with "isolated" diastolic heart failure and diastolic dysfunction. Circulation 2002, 105:1195–1201.PubMedCrossRefGoogle Scholar
  18. 18.
    Astorri E, Fiorina P, Contini GA, et al.: Isolated and preclinical impairment of left ventricular filling in insulin-dependent and non-insulin-dependent diabetic patients. Clin Cardiol 1997, 20:536–540.PubMedGoogle Scholar
  19. 19.
    Friedman NE, Levitsky LL, Edidin DV, et al.: Echocardiographic evidence for impaired myocardial performance in children with type I diabetes mellitus. Am J Med 1982, 73:846–850.PubMedCrossRefGoogle Scholar
  20. 20.
    Vered A, Battler A, Segal P, et al.: Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol 1984, 54:633–637.PubMedCrossRefGoogle Scholar
  21. 21.
    Fang ZY, Yuda S, Anderson V, et al.: Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 2003, 41:611–617. Cross-sectional study showing the role of new quantitative echo parameters in the detection of early diabetic myocardial disease.PubMedCrossRefGoogle Scholar
  22. 22.
    Garvey WT, Hardin D, Juhaszova M, Dominguez JH: Effects of diabetes on myocardial glucose transport system in rats: implications for diabetic cardiomyopathy. Am J Physiol 1993, 264:H837-H844.PubMedGoogle Scholar
  23. 23.
    Rodrigues B, Cam MC, Kong J, et al.: Strain differences in susceptibility to streptozotocin-induced diabetes: effects on hypertriglyceridemia and cardiomyopathy. Cardiovasc Res 1997, 34:199–205.PubMedCrossRefGoogle Scholar
  24. 24.
    Rodrigues B, Cam MC, McNeill JH: Metabolic disturbances in diabetic cardiomyopathy. Mol Cell Biochem 1998, 180:53–57.PubMedCrossRefGoogle Scholar
  25. 25.
    Malone JI, Schocken DD, Morrison AD, Gilbert-Barness E: Diabetic cardiomyopathy and carnitine de.ciency. J Diabetes Complications 1999, 13:86–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Kita Y, Shimizu M, Sugihara N, et al.: Correlation between histopathological changes and mechanical dysfunction in diabetic rat hearts. Diabetes Res Clin Pract 1991, 11:177–188.PubMedCrossRefGoogle Scholar
  27. 27.
    Litwin SE, Raya TE, Anderson PG, et al.: Abnormal cardiac function in the streptozotocin-diabetic rat. Changes in active and passive properties of the left ventricle. J Clin Invest 1990, 86:481–488.PubMedCrossRefGoogle Scholar
  28. 28.
    Stroedter D, Schmidt T, Bretzel RG, Federlin K: Glucose metabolism and left ventricular dysfunction are normalized by insulin and islet transplantation in mild diabetes in the rat. Acta Diabetol 1995, 32:235–243.PubMedCrossRefGoogle Scholar
  29. 29.
    Thompson EW: Structural manifestations of diabetic cardiomyopathy in the rat and its reversal by insulin treatment. Am J Anat 1988, 182:270–282.PubMedCrossRefGoogle Scholar
  30. 30.
    Sykes CA, Wright AD, Malins JM, Pentecost BL: Changes in systolic time intervals during treatment of diabetes mellitus. Br Heart J 1977, 39:255–259.PubMedGoogle Scholar
  31. 31.
    Shapiro LM, Leatherdale BA, Coyne ME, et al.: Prospective study of heart disease in untreated maturity onset diabetics. Br Heart J 1980, 44:342–348.PubMedGoogle Scholar
  32. 32.
    von Bibra H, Hansen A, Dounis V, et al.: Augmented metabolic control improves myocardial diastolic function and perfusion in patients with non-insulin dependent diabetes. Heart 2004, 90:1483–1484. Therapeutic trial showing reversibility of primary myocardial disease with improved glycemic control. Subsequent studies from this group have proposed insulin rather than other hypoglycemic approaches as the best option.CrossRefGoogle Scholar
  33. 33.
    Picano E, Pelosi G, Marzilli M, et al.: In vivo quantitative ultrasonic evaluation of myocardial fibrosis in humans. Circulation 1990, 81:58–64.PubMedGoogle Scholar
  34. 34.
    Fiordaliso F, Li B, Latini R, et al.: Myocyte death in streptozotocin-induced diabetes in rats in angiotensin II-dependent. Lab Invest 2000, 80:513–527.PubMedGoogle Scholar
  35. 35.
    Kajstura J, Fiordaliso F, Andreoli AM, et al.: IGF-1 overexpression inhibits the development of diabetic cardiomyopathy and angiotensin II-mediated oxidative stress. Diabetes 2001, 50:1414–1424.PubMedCrossRefGoogle Scholar
  36. 36.
    Fischer V W, Barner HB, Leskiw ML: Capillary basal laminar thickness in diabetic human myocardium. Diabetes 1979, 28:713–719.PubMedCrossRefGoogle Scholar
  37. 37.
    Kawaguchi M, Techigawara M, Ishihata T, et al.: A comparison of ultrastructural changes on endomyocardial biopsy specimens obtained from patients with diabetes mellitus with and without hypertension. Heart Vessels 1997, 12:267–274.PubMedGoogle Scholar
  38. 38.
    Fang ZY, Najos-Valencia O, Leano R, Marwick TH: Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine. J Am Coll Cardiol 2003, 42:446–453.PubMedCrossRefGoogle Scholar
  39. 39.
    Strauer BE, Motz W, Vogt M, Schwartzkopff B: Impaired coronary flow reser ve in NIDDM: a possible role for diabetic cardiopathy in humans. Diabetes 1997, 46(suppl 2):S119-S124.PubMedGoogle Scholar
  40. 40.
    Sakamoto K, Yamasaki Y, Nanto S, et al.: Mechanism of impaired left ventricular wall motion in the diabetic heart without coronary artery disease. Diabetes Care 1998, 21:2123–2128.PubMedCrossRefGoogle Scholar
  41. 41.
    Hansen A, Johansson BL, Wahren J, von Bibra H: C-peptide exerts bene.cial effects on myocardial blood flow and function in patients with type 1 diabetes. Diabetes 2002, 51:3077–3082.PubMedCrossRefGoogle Scholar
  42. 42.
    Mantysaari M, Kuikka J, Mustonen J, et al.: Measurement of myocardial accumulation of 123I-metaiodobenzylguanidine for studying cardiac autonomic neuropathy in diabetes mellitus. Clin Auton Res 1996, 6:163–169.PubMedCrossRefGoogle Scholar
  43. 43.
    Hartmann F, Ziegler S, Nekolla S, et al.: Regional patterns of myocardial sympathetic denervation in dilated cardiomyopathy: an analysis using carbon-11 hydroxyephedrine and positron emission tomography. Heart 1999, 81:262–270.PubMedGoogle Scholar
  44. 44.
    Allman KC, Stevens MJ, Wieland DM, et al.: Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography. J Am Coll Cardiol 1993, 22:1425–1432.PubMedCrossRefGoogle Scholar
  45. 45.
    Erbas T, Erbas B, Kabakci G, et al.: Plasma big-endothelin levels, cardiac autonomic neuropathy, and cardiac functions in patients with insulin-dependent diabetes mellitus. Clin Cardiol 2000, 23:259–263.PubMedCrossRefGoogle Scholar
  46. 46.
    Scognamiglio R, Fasoli G, Ferri M, et al.: Myocardial dysfunction and abnormal left ventricular exercise response in autonomic diabetic patients. Clin Cardiol 1995, 18:276–282.PubMedGoogle Scholar
  47. 47.
    Scognamiglio R, Avogaro A, Casara D, et al.: Myocardial dysfunction and adrenergic cardiac innervation in patients with insulin-dependent diabetes mellitus. J Am Coll Cardiol 1998, 31:404–412.PubMedCrossRefGoogle Scholar
  48. 48.
    Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group [no authors listed]. BMJ 1998, 317:703–713.Google Scholar
  49. 49.
    Tuomilehto J, Rastenyte D, Birkenhager WH, et al.: Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999, 340:677–684.PubMedCrossRefGoogle Scholar
  50. 50.
    Fang ZY, Schull-Meade R, Downey M, et al.: Determinants of subclinical diabetic heart disease. Diabetologia 2005, 48:394–402.PubMedCrossRefGoogle Scholar
  51. 51.
    Asif M, Egan J, Vasan S, et al.: An advanced glycation endproduct cross-link breaker can reverse age-related increases in myocardial stiffness. Proc Natl Acad Sci U S A 2000, 97:2809–2813.PubMedCrossRefGoogle Scholar
  52. 52.
    Liu J, Masurekar MR, Vatner DE, et al.: Glycation end-product cross-link breaker reduces collagen and improves cardiac function in aging diabetic heart. Am J Physiol Heart Circ Physiol 2003, 285:H2587-H2591. Promising results from a study of cross-link breakers in an animal model.PubMedGoogle Scholar

Copyright information

© Current Science Inc. 2006

Authors and Affiliations

  1. 1.University of Queensland Department of MedicinePrincess Alexandra HospitalBrisbaneAustralia

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