Specifics of Diabetic Cardiomyopathy in the Cases of Concomitant Cardiovascular Diseases: Clinical and Ultrastructural Examinations

Yu.H. Kyyak, H.Yu. Kyyak, O.Yu. Barnett

Abstract


Introduction. The concept of diabetic cardiomyopathy was first proposed by S. Rubler et al. more than 100 years ago, but this diagnosis іs rarely used by clinicians because of the existence of such co-morbidities as ischemic heart disease and arterial hypertension in those patients. Different mechanisms have been implicated in the pathogenesis of diabetic cardiomyopathy, however its specific features are not revealed till now. The aim of the investigation was to reveal the ultrastructural features of cardiomyocyte remodeling, typical for diabetic cardiomyopathy in the cases of concomitant ischemic heart disease and arterial hypertension. Material and methods. Ultrastructure of express-necropsies and intraoperative myocardial biopsies of 25 patients suffering from diabetes mellitus, arterial hypertension and different forms of ishemic heart disease were examined. Results. The ultrastractural mechanisms of cardiomyocyte hibernation, specific for diabetic cardiomyopathy, in comparison with changes characteristic for ischemic heart disease and arterial hypertension, were revealed. Cardiomyocyte hibernation in the cases of diabetes mellitus emergences on the early stages of the illness, prior the appearance of arterial hypertension and ischemic heart disease which cause predominantly their hypertrophy and stunning. Conclusions. Diabetic cardiomyopathy is a consequence of dysmetabolic and microcirculatory disorders causing cardiomyocyte hibernation. Decompensation of diabetes mellitus and the presence of ischemic heart disease or arterial hypertension are the main triggers of diabetic cardiomyopathy development. Hibernated cardiomyocytes die due to apoptosis or secondary necrosis transforming diastolic dysfunction of the left ventricle, typical for diabetes mellitus, into systolic type.


Keywords


diabetic cardiomyopathy; ischemic heart disease; arterial hypertension; diabetes mellitus; cardiomyocyte hibernation

References


Boner G, Cooper ME, McCarroll K.Adverse effects of left ventricular hypertrophy in the reduction of endpoints in NIDDM with the angiotensin II antagonist losartan (RENAAL) study. Diabetologia. 2005;48:1980-1987.

Boudina S, Abel E. Diabetic cardiomyopathy, causes and effects. Rew. Endocr. Metab. Disord. 2010;11(1):31-39.

Bugger H, Dale E. Molecular mechanisms of diabetic cardiomyopathy.Diabetologia. 2014;57(4):660-671.

Kyyak Y, Barnett O,Kovalyshyn V, Besh D. Cardiomyocite and microvascular endothelial cell remodeling and hibernation in hypertension as risk factor for heart failure. Medimond Medical Publication. 2009;147-150.

Bertoni AG, Tsai A, Kasper EK, Brancati FL. Diabetes and idiopathic cardiomyopathy: a nationwide case-control study. Diabetes Care. 2003;26:2791-2795.

Asghar O, Al-Sunni A, Khavandi K. Diabetic cardiomyopathy. Clinical Science. 2009;116:741-760.

Pham I, Cosson E, Nguyen M. Evidence for a Specific Diabetic Cardiomyopathy: An Observational Retrospective Echocardiography Study in 656 Asymptomatic Type 2 Diabetic Patients. Intern. Journal of Endocrinology;2015:1-8.

Guha A, Harmancey R, Taegtmeyer H. Nonischemic heart failure in diabetes mellitus. Curr. Opin. Cardiol. 2008;23(3):241-248.

Bertoni AG, Hundley WG, Massing MW. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care.2004;27:699-703.

Anderson E, Rodriguez E, Anderson C. Increased propensity for cell death in diabetic human heart is mediated by mitochondrial-dependent pathways. Am. J. Physiol. Heart Circ. Physiol. 2011;300:118-124.

Leyden E. Asthma and diabetes mellitus. Zeutschr. Klin. Med. 1881;3:358-364.

Mayer J. Ueber den zusammenhang des diabetes mellitus miterkrankungen des herzens. Zeutschr. Klin. Med.1888;14:212-239.

Rubler S, Dlugash J, Yuceoglu YZ. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am. J. Cardiol. 1972;30:595-602.

Mohammad A, Mahy I, Norton M, Hillis G. Prevalence of hibernating myocardium in patients with severely impaired ischaemic left ventricles. Heart.1998;80:559-564.

Nagueh SF, Mikati I, Weilbaecher D. Relation of the contractile reserve of hibernating myocardial structure in humans. Circulation. 1999;98:490-496.

Dzau V, Antman E, Black H. The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes. Circulation. 2006;114:2850-2870.

Wende A, AbelE. Lipotoxicity in the heart. Biochim. Biophys. Acta. 2010;1801(3):311-319.

KovalyshynVI, LucykOD, KyyakY.H., Barnett O.Y. Histochemical diagnostics of cardiomyocyte hibernation and necrosis in the case of ischemic heart disease. Lvivskyy medychnyy chasopys. 2013;9(4):8-11. (Ukrainian)

KyyakYH, BarnettOY, KovalyshynVI, Kyyak HY. Correlations between clinical and cell cardiology. Lviv, 2012;160 s. (Ukrainian)

KyyakYH, Barnett OY. Remodelling, hibernation, and apoptosis of cardiomyocytes in case of arterial hypertension and myocardial infarction as predictor of heart failure. Liky Ukrayiny.2011;2(6):27-34. (Ukrainian)




DOI: https://doi.org/10.22141/2224-0721.5.77.2016.78751

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