Imaging in diabetic cardiomyopathy

Abstract

Diabetic cardiomyopathy is recognized as a distinct disease entity characterized by left ventricular dysfunction in absence of hypertension or coronary artery disease, and independent of glucose control. Early detection may be particularly important for preventing cardiovascular morbidity and mortality, but prospective evidence for this approach is lacking. The pathophysiology of diabetic cardiomyopathy does not remain completely understood. Besides several animal models, contemporary imaging techniques have helped not only to define this clinical entity, but to also understand pathophysiologic mechanisms. This review aims to highlight the current understanding of the disease process and to discuss current imaging methods and their limitations.

Keywords::

• cardiomyopathy
• cardiac magnetic resonance
• diabetes
• echocardiography

Financial & competing interests disclosure

The authors were supported by the Cardiovascular Clinical Trials Division, University of Toronto. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Diabetic cardiomyopathy (DCM) is an independent disease entity in patients with Type 1 and Type 2 diabetes that is associated with increased morbidity and mortality, irrespective of concomitant comorbidities.

• Proposed key elements leading to DCM include increased free fatty acid metabolism leading to accumulation of reactive oxygen species and direct lipotoxicity; disturbed calcium homeostasis, abnormal glucose control, microvascular disease and autonomic dysfunction.

• Identified phenotypes of DCM are not specific, and there is no single diagnostic modality or set of clinical parameters to diagnose DCM.

• Imaging modalities differ in their imaging targets, and in their ability to detect different elements of DCM.

Notes