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Present Insights on Cardiomyopathy in Diabetic Patients

The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardi...

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Detalles Bibliográficos
Autores principales: Felício, João Soares, Koury, Camila Cavalcante, Carvalho, Carolina Tavares, Neto, João Felício 
Abrahão, Miléo, Karem Barbosa, Arbage, Thaís Pontes, Silva, Denisson Dias, Ferreira de Oliveira, Alana, Peixoto, Amanda Soares, Junior, Antônio Bentes Figueiredo, Ribeiro dos Santos, Ândrea Kely Campos, Yamada, Elizabeth Sumi, Zanella, Maria Teresa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bentham Science Publishers 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101638/
https://www.ncbi.nlm.nih.gov/pubmed/26364799
http://dx.doi.org/10.2174/1573399812666150914120529
Descripción
Sumario:The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management. The novelty of this review is the role of CAN and reduction of blood pressure descent during sleep in the development of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium abnormalities. Considering that DCM could be asymptomatic for a long period and progress to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type 2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities in these tests in the attempt of reducing cardiovascular morbidity and mortality.