Diabetic cardiomyopathy: pathophysiology, imaging assessment and therapeutical strategies
Vincenzo Rizza, Lara Tondi, Angelo Maria Patti, Damiano Cecchi, Massimo Lombardi, Francesco Perone, Marco Ambrosetti, Manfredi Rizzo, Domenico Cianflone, Francesco Maranta
Abstract
Diabetes mellitus (DM) is one of the most prevalent cardiovascular risk factors in the general population, being associated with high morbidity and socioeconomic burden. Diabetic cardiomyopathy (DCM) is a non-negligible complication of DM, whose pathophysiological fundaments are the altered cardiac metabolism, the hyperglycemia-triggered formation of advanced glycation end-products (AGEs) and the inflammatory milieu which are typical in diabetic patients. These metabolic abnormalities lead to cardiomyocytes apoptosis, interstitial fibrosis and mechanical cardiac dysfunction, which can be identified with non-invasive imaging techniques, like echocardiography and cardiac magnetic resonance. This review aims to: 1) describe the major imaging features of DCM; 2) highlight how early identification of DCM-related anatomical and functional remodeling might allow patients' therapy optimization and prognosis improvement.