Present Insights on Cardiomyopathy in Diabetic Patients.
Present Insights on Cardiomyopathy in Diabetic Patients.
复制标题
DOI：
10.2174/1573399812666150914120529
复制
发表时间：
2016
影响因子：
3.3
通讯作者：
Zanella MT
中科院分区：
文献类型：
--
作者：
Felício JS;Koury CC;Carvalho CT;Abrahão Neto JF;Miléo KB;Arbage TP;Silva DD;de Oliveira AF;Peixoto AS;Figueiredo AB;Ribeiro Dos Santos ÂK;Yamada ES;Zanella MT
糖尿病心肌病 (DCM) 的发病机制目前尚不完全清楚，并且可能是多因素的，涉及代谢紊乱、高血压和心血管自主神经病变 (CAN)。因此，仍然需要进一步阐明糖尿病心肌病的基本机制并将其应用于日常临床实践。我们试图详细说明其中一些潜在机制，重点关注临床特征和管理。本综述的新颖之处在于 CAN 和睡眠期间血压下降减少在 DCM 发展中的作用。有证据表明，在血压正常的 2 型糖尿病患者中，CAN 可能先于左心室肥厚和舒张功能障碍，作为评估临床前心脏异常的早期标志物。此外，一项前瞻性研究表明，对于白蛋白尿正常的高血压合并 2 型糖尿病患者，夜间收缩压升高和夜间血压下降可能会先于蛋白尿异常和心血管事件的发生。因此，现有的微量白蛋白尿可能意味着存在心肌异常。考虑到扩张型心肌病可能长期无症状并发展为不可逆的心脏损伤，早期识别和治疗临床前心脏异常对于避免严重的心血管结局至关重要。从这个意义上说，我们建议所有2型糖尿病患者，尤其是微量白蛋白尿患者，应定期进行CAN检查、动态血压监测和超声心动图检查，并对这些检查中的任何异常进行治疗，以降低心血管发病率和死亡率。
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.