Department of Internal Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
Acta Diabetol. 2011 Sep;48(3):173-81. doi: 10.1007/s00592-010-0180-x. Epub 2010 Mar 3.
Diabetic cardiomyopathy has been defined as "a distinct entity characterized by the presence of abnormal myocardial performance or structure in the absence of epicardial coronary artery disease, hypertension, and significant valvular disease". The diagnosis stems from the detection of myocardial abnormalities and the exclusion of other contributory causes of cardiomyopathy. It rests on non-invasive imaging techniques which can demonstrate myocardial dysfunction across the spectra of clinical presentation. The presence of diabetes is associated with an increased risk of developing heart failure, and the 75% of patients with unexplained idiopathic dilated cardiomyopathy were found to be diabetic. Diabetic patients with microvascular complications show the strongest association between diabetes and cardiomyopathy, an association that parallels the duration and severity of hyperglycemia. Metabolic abnormalities (that is hyperglycemia, hyperinsulinemia, and hyperlipemia) can lead to the cellular alterations characterizing diabetic cardiomyopathy (that is myocardial fibrosis and/or myocardial hypertrophy) directly or indirectly (that is by means of renin-angiotensin system activation, cardiac autonomic neuropathy, alterations in calcium homeostasis). Moreover, metabolic abnormalities represent, on a clinical ground, the main therapeutic target in the patients with diabetes since the diagnosis of diabetes is made. Since diabetic cardiomyopathy is highly prevalent in the asymptomatic type 2 diabetic patients, screening for its presence at the earliest stage of development can lead to prevent the progression to chronic heart failure. The most sensitive test is standard echocardiogram, while a less expensive pre-screening method is the detection of microalbuminuria.
糖尿病性心肌病被定义为“一种以心肌功能异常或结构异常为特征的独立实体，而不存在心外膜冠状动脉疾病、高血压和显著的瓣膜疾病”。该诊断源自于心肌异常的检测和心肌病其他致病因素的排除。它依赖于可以在临床表现谱上显示心肌功能障碍的非侵入性成像技术。糖尿病的存在与心力衰竭风险增加相关，并且 75%的原因不明的特发性扩张型心肌病患者被发现患有糖尿病。患有微血管并发症的糖尿病患者表现出糖尿病与心肌病之间最强的关联，这种关联与高血糖的持续时间和严重程度平行。代谢异常（即高血糖、高胰岛素血症和高脂血症）可导致直接或间接导致糖尿病性心肌病的细胞改变（即心肌纤维化和/或心肌肥厚）（即通过肾素-血管紧张素系统激活、心脏自主神经病变、钙稳态改变）。此外，代谢异常代表了患有糖尿病的患者的主要治疗靶点，因为在做出糖尿病诊断时，代谢异常就已经存在。由于糖尿病性心肌病在无症状的 2 型糖尿病患者中非常普遍，因此尽早发现其存在可以防止其进展为慢性心力衰竭。最敏感的检查是标准超声心动图，而一种成本较低的预筛选方法是检测微量白蛋白尿。
