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Diabetic cardiomyopathy
  1. Matthew Meng Yang Lee1,
  2. John J V McMurray1,
  3. Ana Lorenzo-Almorós2,
  4. Søren Lund Kristensen3,
  5. Naveed Sattar1,
  6. Pardeep S Jhund1,
  7. Mark C Petrie1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciónes Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
  3. 3Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Professor Mark C Petrie, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK; mark.petrie{at}glasgow.ac.uk

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Learning objectives

  • Recognise proposed definitions of diabetic cardiomyopathy and debates about its existence.

  • Appreciate the proposed effect of diabetes on the heart via various pathophysiological mechanisms (although not all fully understood).

  • Understand the adverse impact of clinical outcomes of diabetes on heart failure (and vice versa).

  • Be aware of the need for further evidence in this area (especially in patients with diabetes and in those with diabetes and heart failure).

Introduction

Heart failure in patients with diabetes has been recognised since 1876.1 The cardiovascular harm of thiazolidinediones shone the 21st century spotlight on the interaction between these two conditions.2 3 Recent clinical trials reporting cardiovascular benefit of drugs used to treat diabetes have sparked even more interest.4–7 The phrase ‘diabetic cardiomyopathy’ entered the literature in 1972.8 Over subsequent years, there has been a steady increase in the use of the term. There is a debate about the existence of a distinct diabetic cardiomyopathy. Some investigators have used the term ‘diabetic cardiomyopathy’ to describe all effects of diabetes on the heart and cardiovascular system but this is at odds with definitions offered to date.

Definition of ‘diabetic cardiomyopathy’

The key challenge is the lack of a universally accepted and consistently applied definition (table 1).1 8–21 Liu et al report on a condition in which there is ventricular dysfunction in the absence of coronary artery disease.22 Boudina and Abel and Rydén et al (including the European Society of Cardiology in collaboration with the European Association for the Study of Diabetes) require the absence of both coronary artery disease and hypertension.11 18 Aneja et al and Tarquini et al suggest that not only should both coronary artery disease and hypertension be absent but other cardiovascular conditions (eg, valvular heart disease) should be absent as well.12 16 Fang et al and Boudina and …

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