Clinical Perspectives for Diagnosis and Treatment of Diabetic Cardiomyopathy

Published: Jan. 1, 2025

Diabetes mellitus is associated with significant morbidity and premature mortality for which heart failure (HF) a major cause. HF may be due to ischaemia, hypertension, uraemia, or specific diabetic cardiomyopathy (DCM), multiple causes co-exist. A recent systematic review suggests that >40% of people type 2 diabetes have diastolic dysfunction without reduction cardiac systolic function. In 1 known cardiovascular disease, 16% had dysfunction. Early DCM asymptomatic can progress symptomatic via increasing cardiomyocyte hypertrophy death as well fibrosis. The 5-year rate similar worse than many common cancers. There been advances in treatment including sodium-glucose co-transport inhibitors (SGLT2i) angiotensin receptor-neprilysin (ARNi), promising therapies such finerenone glucagon-like peptide-1 receptor agonists (GLP-1RA). SGLT2i, finerenone, GLP-1RA also role prevention DCM. While there currently no goes beyond general treatment, research into innovative technologies gene stem cell therapies. Also, digital will likely an treatment. Herein we the pathophysiology, diagnosis, DCM, focus on existing, emerging, potentially novel We provide practical tables summarise at each stage important practice points commonly prescribed drugs.

Language: Английский

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Association between neutrophil-to-lymphocyte ratio and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus

Frontiers in Endocrinology, Journal Year: 2025, Volume and Issue: 15

Published: Jan. 10, 2025

Diabetes has become a global pandemic, posing sustained threat to human health, primarily due its associated complications. Left ventricular diastolic dysfunction (LVDD) is prevalent cardiac complication among patients with diabetes. Since most are asymptomatic and lack relevant biomarkers, LVDD not attracted significant attention from clinicians. The neutrophil-to-lymphocyte ratio (NLR) widely studied inflammation biomarker that been suggested be linked various medical conditions, including diseases. However, association type 2 diabetes mellitus (T2DM) explored. To clarify the relationship between NLR We conducted cross-sectional study using records 855 diagnosed T2DM who were admitted Endocrinology department at Wuhan Union Hospital. According ASE/EACVI 2016 recommendations, these categorized into two groups based on sonographic parameters: normal left function (the non-LVDD group) group). values calculated divided three different levels. Statistical analysis was evaluate correlation levels prevalence of LVDD. hospitalized in our 47.8% (409/855). mean value group significantly higher compared [1.60 (1.24-2.05) vs 1.85 (1.44-2.31), P<0.001]. 35.51% (76/214), 49.27% (203/412), 56.77% (130/229), respectively. Unjustified logistic showed positively (P <0.001). Compared low level NLR, unadjusted odds ratios (OR) medium high 1.764 (1.255-2.478, P=0.001) 2.384 (1.626-3.497, P<0.001), respectively for trend Our findings suggest potential indicator assisting clinicians identifying T2DM. Patients elevated may greater risk developing than those lower levels, which require interventions prevent progressing heart failure.

Language: Английский

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Molecular Pathways in Diabetic Cardiomyopathy and the Role of Anti-hyperglycemic Drugs Beyond Their Glucose Lowering Effect

Journal of Lipid and Atherosclerosis, Journal Year: 2025, Volume and Issue: 14(1), P. 46 - 46

Published: Jan. 1, 2025

Language: Английский

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Molecular Pathways in Diabetic Cardiomyopathy and the Role of Anti-hyperglycemic Drugs Beyond Their Glucose Lowering Effect

Journal of Lipid and Atherosclerosis, Journal Year: 2025, Volume and Issue: 14(1), P. 54 - 54

Published: Jan. 1, 2025

Epidemiological evidence has shown that diabetes is associated with overt heart failure (HF) and worse clinical outcomes. However, the presence of a distinct primary diabetic cardiomyopathy (DCM) not been easy to prove because association between HF confounded by hypertension, obesity, microvascular dysfunction, autonomic neuropathy. In addition, molecular mechanisms underlying DCM are yet fully understood, usually remains asymptomatic in early stage, no specific biomarkers have identified. Nonetheless, several mechanistic associations at systemic, cardiac, cellular/molecular levels explain different aspects myocardial including impaired cardiac relaxation, compliance, contractility. this review, we focus on recent preclinical advances our understanding role anti-hyperglycemic agents preventing beyond their glucose lowering effect.

Language: Английский

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B-type natriuretic peptide efficacy compared to fragmented QRS for diastolic dysfunction screening in patients with type 2 diabetes

World Journal of Diabetes, Journal Year: 2025, Volume and Issue: 16(4)

Published: Feb. 28, 2025

Early diagnosis of left ventricular diastolic dysfunction (LVDD) is essential for preventing heart failure. B-type natriuretic peptide (BNP) a viable marker predicting LVDD, as elevated BNP levels have been associated with worsening LVDD in patients diabetes over time. However, the utility diagnostic controversial, are often low overweight individuals. To examine effectiveness and fragmented QRS (fQRS) on electrocardiography diagnosing type 2 diabetes. This retrospective cohort study included 303 (67.4 ± 12.3 years old) preserved ejection fraction (EF) ≥ 50% admitted to Toyama University Hospital glycemic management comorbidity evaluation between November 2017 April 2021. All participants underwent plasma measurement, electrocardiography, echocardiography. Cardiologists who were blinded results assessed electrocardiograms echocardiograms. Subgroup analyses conducted Receiver operating characteristic (ROC) curve analysis determined optimal cut-off values 34.8 pg/mL 7.2 non-overweight [area under ROC (AUC): 0.70] (AUC: 0.55) groups, respectively (P = 0.040). In subgroup, fQRS showed greater accuracy 0.67), indicating moderate compared performance cutoff 35 0.52) 0.010). Multivariate confirmed that was superior regardless patient's weight. A level individuals may be reliable marker. Additionally, more effective than irrespective can complement early detection especially patients, potentially improving mitigating progression failure EF

Language: Английский

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Resident Macrophages in the Cervical Sympathetic Ganglia Participate in P2Y12 Receptor Mediated Diabetic Cardiac Autonomic Neuropathy

Molecular Neurobiology, Journal Year: 2025, Volume and Issue: unknown

Published: March 27, 2025

Language: Английский

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Correction of structural damage associated with GABA-derived diabetic cardiomyopathy

Published: April 19, 2025

Diabetes mellitus (DM) is currently considered a serious epidemic worldwide and the leading cause of cardiovascular disease mortality in patients with DM. Diabetic cardiomyopathy (DCM) absence coronary heart disease, defects, arterial hypertension, etc. multifactorial to ventricular hypertrophy, interstitial fibrotic changes failure. Materials methods. The modeling diabetes was carried out for six months, after which treatment succicard aminalon 1000 mg/kg. negative control group administered physiological saline. After treatment, morphological were studied, weight, cardiomyocyte diameter fibrosis severity left myocardium measured. Results discussion. animals DM showed development hypertrophy (LV) myocardium. Age-related contributed an increase fibrosis. use demonstrated pronounced protective effect, manifested by restoration morphometric parameters may be associated membrane cardioprotective properties succicard, aimed at normalizing metabolic processes cardiomyocytes protecting vascular endothelium. Conclusions. obtained data confirm prospects using correction functional myocardial disorders diabetic cardiomyopathy, especially conditions comorbid such as aging.

Language: Английский

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The effect of empagliflozin on peripheral microvascular dysfunction in patients with heart failure with preserved ejection fraction

Cardiovascular Diabetology, Journal Year: 2025, Volume and Issue: 24(1)

Published: April 25, 2025

Abstract Background Empagliflozin is an effective treatment for heart failure with preserved ejection fraction (HFpEF), but its definite mechanism of action unclear. Systemic microvascular dysfunction strongly relates to HFpEF aetiology, and we hypothesised that empagliflozin improves function in HFpEF. Objective To investigate the effect sodium–glucose cotransporter-2 inhibitor on peripheral Methods This a pre-post intervention study patients diagnosed who are eligible empagliflozin. Microvascular assessment using laser speckle contrast analysis dorsal forearm during iontophoresis vasoactive stimuli (acetylcholine, insulin sodium nitroprusside) was performed at baseline after 3 months (10 mg daily). The primary outcome difference blood flow measured microvasculature between follow-up (cutaneous vascular conductance, CVC). Secondarily investigated quality-of-life based EQ-5D-5 L questionnaire follow-up. Results Twenty six finished according protocol (mean age 74 ± 7 years, 62% female). We observed decreased response acetylcholine (CVC: 0.77 0.24 vs. 0.64 0.20, p < 0.001). In contrast, improved 0.61 0.43 0.81 0.32, = 0.03), nitroprusside remained stable months. No significant correlations were found changes quality life. Conclusion shows three changed may enhance specifically via actions insulin, rather than general endothelial vasoregulation or smooth muscle cell function. As such, systemic can be modifiable factor HFpEF, while clinical implications thereof warrant further investigations. Trial registration trial preregistered clinicaltrials.gov (NCT06046612). Graphical abstract

Language: Английский

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Finerenone: Potential Clinical Application Across the Spectrum of Cardiovascular Disease and Chronic Kidney Disease

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(9), P. 3213 - 3213

Published: May 6, 2025

Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD) and a risk factor for progression to end-stage cardiovascular morbidity mortality. Despite pharmacologic treatment, residual adverse outcomes remains substantial. Finerenone nonsteroidal mineralocorticoid receptor antagonist (MRA) approved in United States use patients with CKD associated T2D. The present review focuses on finerenone use, including its basis, indication eligibility, practical aspects incorporation into routine clinical practice (particularly primary care). Results from two placebo-controlled phase 3 trials (plus maximum tolerated dose renin-angiotensin-aldosterone system inhibitor) T2D showed significantly lower events versus placebo. These effects were applicable across broad spectrum patient participants, those baseline comorbidities such as history heart failure or atherosclerotic disease. We also compare steroidal MRAs discuss relevance ongoing recently completed other groups, which could expand further broader patients.

Language: Английский

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The effects of SGLT2i on cardiac metabolism in patients with HFpEF: Fact or fiction?

Cardiovascular Diabetology, Journal Year: 2025, Volume and Issue: 24(1)

Published: May 14, 2025

The rising prevalence of Type 2 diabetes (T2D) has been closely associated with an increased incidence cardiovascular diseases, particularly heart failure preserved ejection fraction (HFpEF). Cardiometabolic disturbances in T2D, such as insulin resistance, hyperglycemia, and dyslipidemia, contribute to both microvascular macrovascular complications, thereby intensifying the risk failure. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed glucose-lowering agents for have demonstrated promising benefits patients failure, including those (HFpEF), regardless T2D status. These include reduced hospitalization rates improvements various metabolic parameters. This review aims critically examine effects SGLT2i on cardiac metabolism HFpEF, evaluating whether observed can truly be attributed their impact myocardial energy regulation or they represent other, potentially confounding, mechanisms. We will focus key processes possibly modulated by SGLT2i, glucose utilization, fatty acid oxidation, mitochondrial function, explore pathophysiology. Additionally, we address role other pathogenetic factors involved sodium fluid balance, inflammation, fibrosis, question extent which these mechanisms clinical benefits. By synthesizing current evidence, this provide in-depth analysis through may influence assessing are supported robust scientific data remain speculative. also discuss potential personalized treatment strategies, based individual patient characteristics, optimize therapeutic managing risk. seeks clarify true utility management cardiometabolic diseases offering insights into improving long-term outcomes.

Language: Английский

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