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Review
. 2021 Jun 30:8:695792.
doi: 10.3389/fmed.2021.695792. eCollection 2021.

The Diabetic Cardiomyopathy: The Contributing Pathophysiological Mechanisms

Teresa Salvatore  1 , Pia Clara Pafundi  2 , Raffaele Galiero  2 , Gaetana Albanese  2 , Anna Di Martino  2 , Alfredo Caturano  2 , Erica Vetrano  2 , Luca Rinaldi  2 , Ferdinando Carlo Sasso  2
Affiliations
Review

The Diabetic Cardiomyopathy: The Contributing Pathophysiological Mechanisms

Teresa Salvatore et al. Front Med (Lausanne). .

Abstract

Individuals with diabetes mellitus (DM) disclose a higher incidence and a poorer prognosis of heart failure (HF) than non-diabetic people, even in the absence of other HF risk factors. The adverse impact of diabetes on HF likely reflects an underlying "diabetic cardiomyopathy" (DM-CMP), which may by exacerbated by left ventricular hypertrophy and coronary artery disease (CAD). The pathogenesis of DM-CMP has been a hot topic of research since its first description and is still under active investigation, as a complex interplay among multiple mechanisms may play a role at systemic, myocardial, and cellular/molecular levels. Among these, metabolic abnormalities such as lipotoxicity and glucotoxicity, mitochondrial damage and dysfunction, oxidative stress, abnormal calcium signaling, inflammation, epigenetic factors, and others. These disturbances predispose the diabetic heart to extracellular remodeling and hypertrophy, thus leading to left ventricular diastolic and systolic dysfunction. This Review aims to outline the major pathophysiological changes and the underlying mechanisms leading to myocardial remodeling and cardiac functional derangement in DM-CMP.

Keywords: cardiomyopathy; diabetes mellitus; heart failure; insulin resistance; pathophysiology.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pathophysiology of diabetic cardiomyopathy.
Figure 2
Figure 2
Pathogenic scheme of hypertrophy and fibrosis in the diabetic cardiomyopathy.
See this image and copyright information in PMC

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