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Diabetische Herzinsuffizienz

Heart failure in diabetes

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Summary

Interactions of glucose metabolism and chronic heart failure have been confirmed by many epidemiologic studies. The association of HbA1c with an increasing risk of heart failure clearly underlines the connection between both diseases. Coronary artery disease (CAD), hypertension and diabetic cardiomyopathy are long-term complications of diabetes mellitus, resulting in diabetic heart failure. Dysfunction of many regulation systems leads to specific diabetic cardiomyopathy, which has been firstly described by Rubler. A reduction in the cardiac expression of the Na-Ca exchanger pump and SERCA2a protein results in an imbalance in cardiac calcium handling. The overactive renin angiotensin aldosteron system (RAAS) also contributes to the impairment of myocardial function. Hyperlipidaemia, hpyerinsulinaemia and hyperglycaemia directly trigger diabetic cardiomyopathy. Generally chronic heart failure is a clinical diagnosis verified by blood tests like NT-proBNP and cardiac ultrasound. Recommendations on treatment of diabetic heart failure are based on subgroup analysis of the large heart failure trials.

Zusammenfassung

Epidemiologische Daten belegen die wechselseitige Beeinflussung von chronischer Herzinsuffizienz (CHF) und Diabetes mellitus. So ist ein Anstieg des HbA1c mit einem gesteigerten Risiko an einer Herzinsuffizienz zu erkranken verbunden. Koronare Herzkrankheit (KHK), Hypertonie und diabetische Kardiomyopathie sind Spätfolgen des Diabetes, deren gemeinsame Endstrecke die diabetische Herzinsuffizienz darstellt. Das spezifische Krankheitsbild der diabetischen Kardiomyopathie wurde von Rubler erstbeschrieben und ist das Endprodukt zahlreicher Störungen verschiedenster Systeme. So ist beispielsweise die kardiale Expression des Natrium-Kalziumaustauschers und des SERCA2a Proteins reduziert, was eine gestörte myokardiale Kalziumhomöostase zur Folge hat. Auch das überaktive Renin-Angiotensin-Aldosteronsystem (RAAS) spielt eine bedeutende Rolle in der Pathogenese der diabetischen Herzinsuffizienz. Hyperlipidämie, Hyperinsulinämie sowie Hypgerglykämie sind Stoffwechselstörungen, die ebenfalls die Entstehung der diabetische Kardiomyopathie begünstigen. Generell ist die Herzinsuffizienz eine klinische Diagnose, die mit Hilfe von Labortests wie dem NT-proBNP, aber auch apparativ verifiziert werden muss. Die derzeitigen Therapieempfehlungen beruhen auf Subgruppenanalysen der großen Herzinsuffizienzstudien.

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  1. Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Austria

    Michael Resl & Martin Clodi

  2. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Wien, Austria

    Martin Hülsmann & Richard Pacher

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  1. Michael Resl
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Resl, M., Hülsmann, M., Pacher, R. et al. Diabetische Herzinsuffizienz. Wien Med Wochenschr 159, 134–140 (2009). https://doi.org/10.1007/s10354-009-0645-0

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