Lam Carolyn Sp
National Heart Centre Singapore and Duke-National University of Singapore, Singapore
Diab Vasc Dis Res. 2015 Jul;12(4):234-8. doi: 10.1177/1479164115579006. Epub 2015 Apr 23.
Heart failure is now recognized as a progressive disease in which patients transition through the stages of being at risk of heart failure (stage A), to asymptomatic structural heart disease (stage B), to clinical manifestations of heart failure (stage C) and finally end-stage or refractory heart failure (stage D). This review outlines the key role of diabetes mellitus as a stage A risk factor for heart failure with preserved ejection fraction, and asymptomatic diabetic cardiomyopathy, referring to the presence of left ventricular diastolic dysfunction in diabetic patients without coronary artery disease, hypertension or other potential aetiologies, as an expression of stage B heart failure with preserved ejection fraction at high risk of transitioning to symptomatic stage C heart failure with preserved ejection fraction. The data presented call for better recognition of the unique phenotype of diabetic cardiomyopathy with preserved ejection fraction and elevated diastolic stiffness as a manifestation of stage B heart failure with preserved ejection fraction that should be targeted for risk management and preventive strategies.
心力衰竭目前被认为是一种进行性疾病，患者会经历从有心力衰竭风险阶段（A期），到无症状性结构性心脏病阶段（B期），再到心力衰竭临床表现阶段（C期），最终发展为终末期或难治性心力衰竭阶段（D期）。本综述概述了糖尿病作为射血分数保留的心力衰竭A期风险因素以及无症状性糖尿病性心肌病的关键作用，将无冠状动脉疾病、高血压或其他潜在病因的糖尿病患者出现左心室舒张功能障碍视为射血分数保留的心力衰竭B期的一种表现，这类患者具有较高风险转变为有症状的射血分数保留的心力衰竭C期。所呈现的数据呼吁更好地认识射血分数保留且舒张硬度升高的糖尿病性心肌病这一独特表型，它是射血分数保留的心力衰竭B期的一种表现，应针对其进行风险管理和预防策略。
