Mohan Mohapradeep, Dihoum Adel, Mordi Ify R, Choy Anna-Maria, Rena Graham, Lang Chim C
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
Front Cardiovasc Med. 2021 Sep 29;8:746382. doi: 10.3389/fcvm.2021.746382. eCollection 2021.
Heart failure is an important manifestation of diabetic heart disease. Before the development of symptomatic heart failure, as much as 50% of patients with type 2 diabetes mellitus (T2DM) develop asymptomatic left ventricular dysfunction including left ventricular hypertrophy (LVH). Left ventricular hypertrophy (LVH) is highly prevalent in patients with T2DM and is a strong predictor of adverse cardiovascular outcomes including heart failure. Importantly regression of LVH with antihypertensive treatment especially renin angiotensin system blockers reduces cardiovascular morbidity and mortality. However, this approach is only partially effective since LVH persists in 20% of patients with hypertension who attain target blood pressure, implicating the role of other potential mechanisms in the development of LVH. Moreover, the pathophysiology of LVH in T2DM remains unclear and is not fully explained by the hyperglycemia-associated cellular alterations. There is a growing body of evidence that supports the role of inflammation, oxidative stress, AMP-activated kinase (AMPK) and insulin resistance in mediating the development of LVH. The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.
心力衰竭是糖尿病性心脏病的重要表现。在出现有症状的心力衰竭之前，多达50%的2型糖尿病（T2DM）患者会出现无症状性左心室功能障碍，包括左心室肥厚（LVH）。左心室肥厚（LVH）在T2DM患者中非常普遍，并且是包括心力衰竭在内的不良心血管结局的有力预测指标。重要的是，通过降压治疗，尤其是肾素血管紧张素系统阻滞剂使LVH消退，可降低心血管发病率和死亡率。然而，这种方法仅部分有效，因为在达到目标血压的高血压患者中，仍有20%的患者存在LVH，这表明其他潜在机制在LVH的发生发展中起作用。此外，T2DM中LVH的病理生理学仍不清楚，高血糖相关的细胞改变也不能完全解释其发生机制。越来越多的证据支持炎症、氧化应激、AMP激活的蛋白激酶（AMPK）和胰岛素抵抗在介导LVH发生发展中的作用。识别无症状性LVH可能为这些高危患者的心脏保护治疗提供一个合适的干预靶点。在本文中，我们综述了一些关键的临床研究，这些研究评估了别嘌醇、SGLT2抑制剂和二甲双胍对有或无T2DM患者LVH消退的影响。
