title: Present Insights on Cardiomyopathy in Diabetic Patients.
abstract: The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management. The novelty of this review is the role of CAN and reduction of blood pressure descent during sleep in the development of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium abnormalities. Considering that DCM could be asymptomatic for a long period and progress to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type 2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities in these tests in the attempt of reducing cardiovascular morbidity and mortality.
authors.affiliation: Hospital Universitário João de Barros Barreto - Universidade Federal do Pará, Mundurucus Street, 4487 - Postal Code: 66073-000 - Guamá - Belém - PA - Brazil. felicio.bel@terra.com.br.
authors.forename: João Soares
authors.initials: JS
authors.lastname: Felício
authors.forename: Camila Cavalcante
authors.initials: CC
authors.lastname: Koury
authors.forename: Carolina Tavares
authors.initials: CT
authors.lastname: Carvalho
authors.forename: João Felício
authors.initials: JF
authors.lastname: Abrahão Neto
authors.forename: Karem Barbosa
authors.initials: KB
authors.lastname: Miléo
authors.forename: Thaís Pontes
authors.initials: TP
authors.lastname: Arbage
authors.forename: Denisson Dias
authors.initials: DD
authors.lastname: Silva
authors.forename: Alana Ferreira
authors.initials: AF
authors.lastname: de Oliveira
authors.forename: Amanda Soares
authors.initials: AS
authors.lastname: Peixoto
authors.forename: Antônio Bentes
authors.initials: AB
authors.lastname: Figueiredo
authors.forename: Ândrea Kely Campos
authors.initials: ÂK
authors.lastname: Ribeiro Dos Santos
authors.forename: Elizabeth Sumi
authors.initials: ES
authors.lastname: Yamada
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Zanella
mesh_terms: D000419:Albuminuria / Q000150:complications / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000209:etiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications / Q000503:physiopathology; D006801:Humans