ABSTRACT
Introduction Diabetes mellitus is associated with an increased prevalence of congestive heart failure (CHF), which is a major cause of morbidity and mortality.1 This observation raised the spectre of a specific diabetes-associated cardiac disease that manifests as heart failure, independent of coronary heart disease or valvular disease – a diabetic cardiomyopathy. This concept has been supported by a series of reports describing heart failure in patients with diabetes that is associated with characteristic (although not specific) cardiac structural and functional changes, characteristic histopathological changes in the myocardium and a range of less well characterized biochemical disturbances in cardiac muscle. This has prompted debate as to whether ‘diabetic cardiomyopathy’ is a specific pathological entity, or a spectrum of changes representing a predictable cardiac structural and functional response to elevated systemic blood pressure, ‘silent myocardial ischaemia’ and disturbances to the metabolic milieu.2 The debate surrounding this important clinical complication of diabetes has been fuelled by numerous studies reporting findings in small numbers of patients that are often poorly characterized, particularly with regard to their blood pressure. Thus, apart from a few exceptions, the debate has been hindered by a remarkable lack of firm evidence or systematic detailed study of the heart beyond coronary disease in people
with diabetes. This chapter reviews the current evidence supporting the concept of a specific diabetic cardiomyopathy from an epidemiological, cardiac structural, functional, histological and biochemical perspective.
