DIABETIC CARDIOMYOPATHY

DR MOUZAOUI K./ DR BENOUARET F.

PR BENKHEDDA

CADIOLOGY A2 DEPARTMENT

PLAN

I/ INTRODUCTION_ GENERALITIES

II/ INCIDENCE

III/DEFINITION

IV/PATHOPHYSIOLOGY

V/DIAGNOSIS

VI/TREATMENT

VII/PREVENTION

VIII/CONCLUSION

I/INTRODUCTION _ GENERALITIES :

>400 MILLIONS

PEOPLE WITH

DIABETE

CV EVENTS: 1.1

millions deaths/year

DIABETES MELLITUS AND CARDIOVASCULAR EVENTS

HEART FAILURE AND DIABETES : VERY BAD

ASSOCIATION !!!

III/INCIDENCE OF HEART FAILURE IN

PATIENT WITH DM :

✓ 17 000 patients without HF

(8232 DM – 8845 control group)

✓ Outcome : incidence of heart

failure after six years

American cohort

HBA1C AND HF RISK :

48858 patients T2D without HF

followed during 02 years

Hospitalization and deaths

related to HF

Analysis according to HbA1c

For each 1% increase in glycosylated haemoglobin (HbA1C),

there is a 8% risk increment for HF independent of ischemic

heart disease and hypertension

HEART FAILURE ; NOT ALWAYS ISCHEMIC!!!

So; can diabetes be an

etiology of heart failure?

DIABETIC CARDIOMYOPATHY_ OBSRVATIONAL DATA

Rubler S et al; New type of cardiomyopathy associated with

diabetic glomerulosclerosis;

Am J cardiol 1972.

04 diabetics patients with congestive heart failure without

hypertension ; coronary disease ;valvular disease or congenital

heart disease.

III /DEFINITION:

WHO : 1995 ; cardiomyopathies are defined as

diseases of the myocardium associated with

cardiac dysfunction

DEFINITION :

IV/PATHOPHYSIOLOGY :

TWO PHENOTYPS

DMCMP

HFPEF

DMCMP

HFREF

IV/PATHOPHYSIOLOGY :

Lipotoxicity

AGEsdeposition

Microvascularrarefaction

Insulinresistance/

Hyperinsulinemia

Hyperglycemia

DMCMP

IV/PATHOPHYSIOLOGY :

PATHOPHYSIOLOGY : HF PEF

PATHOPHYSIOLOGY : HF REF

V/DIAGNOSTIC CRITERIA FOR DIABETIC

CARDIOMYOPATHY :

Diabetes mellitus is a slowly progressing disease;

is it possible to detect this disease earlier?

MYOCARDIAL TISSUE DOPPLER IMAGING

CLINICAL SCIENCE 2003

REDUCED MYOCARDIAL VELOCITIES IN

DIABETICS PATIENTS

HD MRI : SHOWED LV STRAIN IN ASYPMTOMATIC

PATIENTS WITH T2D :

VI/TREATMENT :

TREATMENT HF REF :

TREATMENT : HFPEF

Choice of glucose lowering

pharmacotherapy in

patients with DM at high

risk for hf or established hf

Drugs that increase heart failure hospitalizations : THIAZOLIDINIDIONE

European Heart Journal 2010

RECORD TRIAL PRO ACTIVE TRIAL

DRUGS THAT INCREASE HEART FAILURE HOSPITALIZATIONS :

DIPEPTIDYL PEPTIDASE-4 (DPP4) INHIBITOR :

SAVOR-TIMI 53 TRIAL

ANTIDIABETIC DRUGS THAT MIGHT BE SAFE IN

HEART FAILURE

DRUGS THAT MIGHT INCREASE THE RISK FOR

HEART FAILURE :

VII/PREVENTION OF HEART FAILURE IN

ASYMPTOMATIQUE DIABETIC PATIENTS :

WHAT ABOUT SGLT2 INHIBITOR ?

CANVAS TRIAL