Salvatore Teresa, Pafundi Pia Clara, Galiero Raffaele, Albanese Gaetana, Di Martino Anna, Caturano Alfredo, Vetrano Erica, Rinaldi Luca, Sasso Ferdinando Carlo
Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
Front Med (Lausanne). 2021 Jun 30;8:695792. doi: 10.3389/fmed.2021.695792. eCollection 2021.
Individuals with diabetes mellitus (DM) disclose a higher incidence and a poorer prognosis of heart failure (HF) than non-diabetic people, even in the absence of other HF risk factors. The adverse impact of diabetes on HF likely reflects an underlying "diabetic cardiomyopathy" (DM-CMP), which may by exacerbated by left ventricular hypertrophy and coronary artery disease (CAD). The pathogenesis of DM-CMP has been a hot topic of research since its first description and is still under active investigation, as a complex interplay among multiple mechanisms may play a role at systemic, myocardial, and cellular/molecular levels. Among these, metabolic abnormalities such as lipotoxicity and glucotoxicity, mitochondrial damage and dysfunction, oxidative stress, abnormal calcium signaling, inflammation, epigenetic factors, and others. These disturbances predispose the diabetic heart to extracellular remodeling and hypertrophy, thus leading to left ventricular diastolic and systolic dysfunction. This Review aims to outline the major pathophysiological changes and the underlying mechanisms leading to myocardial remodeling and cardiac functional derangement in DM-CMP.
糖尿病患者发生心力衰竭（HF）的发生率高于非糖尿病患者，且预后更差，即使不存在其他HF危险因素也是如此。糖尿病对HF的不利影响可能反映了潜在的“糖尿病性心肌病”（DM-CMP），左心室肥厚和冠状动脉疾病（CAD）可能会加剧这种情况。自首次描述以来，DM-CMP的发病机制一直是研究的热点，目前仍在积极研究中，因为多种机制之间的复杂相互作用可能在全身、心肌和细胞/分子水平上发挥作用。其中包括代谢异常，如脂毒性和糖毒性、线粒体损伤和功能障碍、氧化应激、异常钙信号传导、炎症、表观遗传因素等。这些紊乱使糖尿病心脏易于发生细胞外重塑和肥大，从而导致左心室舒张和收缩功能障碍。本综述旨在概述导致DM-CMP中心肌重塑和心脏功能紊乱的主要病理生理变化及其潜在机制。
