Predictors and prevention of diabetic cardiomyopathy.
Predictors and prevention of diabetic cardiomyopathy.
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DOI：
10.2147/dmso.s30968
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Mishra PK
中科院分区：
文献类型：
--
作者：
Chavali V;Tyagi SC;Mishra PK
尽管我们认识到糖尿病可以增加心力衰竭的机会，导致多器官衰竭，并有助于发病率和死亡率，但它在世界范围内正在迅速增加威胁。通过确定糖尿病心肌病（DCM）的综合预测因子和使用新的方法改善DCM，对糖尿病前期患者进行预警的关注较少。DCM被认为是糖尿病患者心脏中无症状的进行性结构和功能重塑，而不存在冠状动脉粥样硬化和高血压。DCM的三个主要阶段是：（1）早期阶段，其中发生细胞和代谢变化而没有明显的收缩功能障碍;（2）中期阶段，其特征在于细胞凋亡增加、左心室尺寸轻微增加和舒张功能障碍，并且其中射血分数（EF）<50%;和（3）晚期，其特征在于微血管顺应性的改变、左心室大小的增加和导致心力衰竭的心脏性能的降低。最近的研究表明，扩张型心肌病是多因素的性质和细胞，分子和代谢的扰动倾向于并有助于扩张型心肌病。在DCM中表现出参与葡萄糖代谢、高脂血症、晚期糖原终产物、心脏细胞外基质重塑以及驻留心脏干细胞存活和分化的改变的microRNA（miRNA）、信号分子的差异表达。久坐不动的生活方式和高脂肪饮食会导致肥胖，这会导致2型糖尿病和DCM。然而，运动训练可以改善2型糖尿病患者的胰岛素敏感性、心肌细胞的收缩力和心脏功能。这些发现为诊断和减轻DCM提供了新的线索。本文综述了扩张型心肌病领域的进展，旨在阐明扩张型心肌病预测因子和预防的未来前景。
Despite our cognizance that diabetes can enhance the chances of heart failure, causes multiorgan failure,and contributes to morbidity and mortality, it is rapidly increasing menace worldwide. Less attention has been paid to alert prediabetics through determining the comprehensive predictors of diabetic cardiomyopathy (DCM) and ameliorating DCM using novel approaches. DCM is recognized as asymptomatic progressing structural and functional remodeling in the heart of diabetics, in the absence of coronary atherosclerosis and hypertension. The three major stages of DCM are: (1) early stage, where cellular and metabolic changes occur without obvious systolic dysfunction; (2) middle stage, which is characterized by increased apoptosis, a slight increase in left ventricular size, and diastolic dysfunction and where ejection fraction (EF) is <50%; and (3) late stage, which is characterized by alteration in microvasculature compliance, an increase in left ventricular size, and a decrease in cardiac performance leading to heart failure. Recent investigations have revealed that DCM is multifactorial in nature and cellular, molecular, and metabolic perturbations predisposed and contributed to DCM. Differential expression of microRNA (miRNA), signaling molecules involved in glucose metabolism, hyperlipidemia, advanced glycogen end products, cardiac extracellular matrix remodeling, and alteration in survival and differentiation of resident cardiac stem cells are manifested in DCM. A sedentary lifestyle and high fat diet causes obesity and this leads to type 2 diabetes and DCM. However, exercise training improves insulin sensitivity, contractility of cardiomyocytes, and cardiac performance in type 2 diabetes. These findings provide new clues to diagnose and mitigate DCM. This review embodies developments in the field of DCM with the aim of elucidating the future perspectives of predictors and prevention of DCM.