Diabetic Cardiomyopathy: Echocardiographic and Clinical Characteristics


Slavica Mitrovska, MD, PhD
Specialist of Internal Medicine, PhD in Cardiology, PHO Promedika Medical Center, Skopje, Republic of Macedonia

Silvana Jovanova, MD, PhD
University Clinic of Cardiology, Skopje, Republic of Macedonia

Series: Cardiology Research and Clinical Developments
BISAC: MED010000

Background: Diabetic cardiomyopathy is defined as heart failure independent of the coronary artery, valve disease and hypertension. It has multifactorial aetiology but the pathogenesis is incompletely understood. Hyperglycemia, hyperlipidemia and inflammation with high oxidative stress lead to structural and functional alterations of the left ventricle (LV) and promote diabetic cardiomyopathy.

Diastolic dysfunction is an early sign of diabetic cardiomyopathy. It has a long asymptomatic period, but with time leads to loss of contractile function. Hence, the identification of subclinical diabetic cardiomyopathy and correction of potentially modified risk factors are very important to delay the onset of heart failure.

The aim: We aimed to assess the LV function in asymptomatic diabetic patients and its correlation with clinical and biochemical parameters.

Study design: Cross-sectional study that includes a total number of 137 subjects. The target group consists of 72 asymptomatic normotensive patients with diabetes mellitus type 2, without coronary artery and valve disease. The control group is composed of 65 healthy subjects.

Methods: All patients were subject to echocardiography (conventional 2D, M-mode, PW Doppler analysis and contemporary techniques-TDI and 2D-Speckle-Tracking Echocardiography). We evaluate LV diastolic and systolic function and its correlation with basic clinical characteristics (age, gender, BMI, BSA, waist to hip ratio, duration of diabetes) and biochemical analyses (glucose profile, lipid profile, CRP). The correlation between clinical, biochemical and echocardiographic parameters was assessed by the Pearson Product Moment of Correlation. A p-value of < 0.05 was considered to indicate significance.

Results: Analysis of deformation identify the greatest number of subjects with abnormal myocardial mechanics (n=45, 62%). Wilcoxon Matched Pairs Test showed a statistically significant difference between the groups regarding the prevalence of diastolic dysfunction, in each imaging modality-PWD and TDI (Z=2.3, p=0.01; Z=2.9, p=0.003). There were strong negative correlations between clinical, biochemical and echocardiographic parameters of PW Doppler and 2D Speckle-Tracking Echocardiography and strong positive correlation with TDI.

Conclusion: Doppler echocardiography is a valuable imaging technique for identifying LV dysfunction in asymptomatic patients with diabetes, and is an important part of the diagnostic algorithm in diabetic cardiomyopathy. Novel Doppler-echocardiographic techniques as are Tissue Doppler Imaging and Speckle-Tracking Echocardiography show superiority over other echocardiographic methods, regarding the early detection of LV functional abnormalities in the asymptomatic diabetic population. Its introduction in daily routine will contribute to the timely initiation of treatment of risk factors, to prevent the development of heart failure
(Imprint: Nova Medicine and Health)



Table of Contents

Chapter 1. Acknowledgements

Chapter 2. Abstract

Chapter 3. State of the Art

Chapter 4. Epidemiology

Chapter 5. Definition of Diabetic Cardiomyopathy

Chapter 6. Aetiology

Chapter 7. Metabolic Factors

Chapter 8. Impaired Glucose Metabolism and Glucotoxicity

Chapter 9. Impaired Metabolism of Lipids and Lipotoxicity

Chapter 10. Increased Oxidative Stress, Increased the Production of Reactive Oxygen Species

Chapter 11. The Role of Transcription Factor 1 (Foxo1) To Control the Expression of Genes in the Pathogenesis of Diabetic Cardiomyopathy

Chapter 12. Pathophysiological Mechanisms in the Development of Diabetic Cardiomyopathy

Chapter 13. Pathophysiological Mechanisms in the Development of Diastolic Heart Failure

Chapter 14. Activation of Compensatory Mechanisms

Chapter 15. Diagnosis of Diabetic Cardiomyopathy

Chapter 16. Clinical Characteristics of Diabetic Cardiomyopathy

Chapter 17. Assessment of Left Ventricular Function

Chapter 18. Echocardiographic Analysis of the Left Ventricle

Chapter 19. Study Protocol

Chapter 20. Motive for Study Research

Chapter 21. Hypothesis

Chapter 22. The Aims of the Study

Chapter 23. The Specific Objective

Chapter 24. The Endpoints

Chapter 25. Project Description

Chapter 26. Design of the Project

Chapter 27. The Overall Concept of the Study

Chapter 28. Study Period

Chapter 29. Study Plan

Chapter 30. Study Population

Chapter 31. Characteristics of the Study Subjects

Chapter 32. Methodology

Chapter 33. Biochemical Analysis: The Methodology of Analysis of Selected Laboratory-Biochemical Markers of Cardiovascular Stress

Chapter 34. Clinical Study Evaluation: Statistical Analysis

Chapter 36. Dissemination and Recommendation

Chapter 37. Implementation

Chapter 38. Work Plan-Work Packages

Chapter 39. Results

Chapter 40. Comparison between the Echocardiographic Techniques in Terms of Detection of Diastolic Dysfunction

Chapter 41. Correlation between Clinical Characteristics and Echocardiographic Parameters

Chapter 42. Correlation between Demographic/Clinical Characteristics with Left Ventricular Function

Chapter 43. Correlation between Anthropometric Characteristics and Left Ventricular Function

Chapter 44. Correlations between Laboratory-Biochemical Parameters and Left Ventricular Function

Chapter 45. Correlation between the Glycemic Profile and Left Ventricular Function

Chapter 46. Correlation between Lipid Profile and Left Ventricular Function

Chapter 47. Correlation between Hyperlipidemia and Left Ventricular Function

Chapter 48. Correlation between a Marker of Inflammation CRP and Left Ventricular Function

Chapter 49. Correlation between Left Ventricular Mass and Left Ventricular Function

Chapter 50. Correlation between the Use of Statins and Left Ventricular Function

Chapter 51. Correlation between the Type of Treatment of Diabetes and Left Ventricular Function

Chapter 52. Discussion

Chapter 53. Literature

Keywords: Diabetic cardiomyopathy, Diabetes mellitus, Left ventricular dysfunction, Tissue Doppler Imaging, Speckle-Tracking Echocardiography.

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