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Cardio Diabetes Medicine 2017 231

SYSTOLIC DYSFUNCTION this later stage diabetic cardiomyopathy diabetic co-
morbidities such as hypertension dyslipidemia. Mi-
In the diabetic heart systolic dysfunctiuon is belived to crovascular dysfunction autonomic dysfunction and
be a later manifestaition of disease Usually ocurring renal impairment may accelerated the progression of
after the development of systolic dysfunction. cardiac dysfunction. Among hospitalized CHF patient
Recently the use of two dimensional speckle tracking those with DM tended to more to more frequently
echocardiography has shown the reasons of subclinical present with acute pulmonary edema or acute coro-
LV systolic dysfunction, measures as a decrease in nary syndrome CHF and renal impairment were the
LV longitudinal shortening in asymptomatic diabetic main determinants of outcome in patient with DM
patients with normal EF and assumed to have “isloated” and CAD and conversely DM is a potent indepen-
diastolic dysfunction., dent risk factor for motility in patients hospitalized
Subjects with type 2 DM are more susceptible to with CHF particularly in women. Glycemic control is
preclinical diastolic and systolic dysfunction com- important prognostic factor as shown in a large co-
pared to type 1 patients supporting a role of insulin hort of diabetic patients (25958) men and (22900)
resistant mediated alterations in the determination of women, in which each 1% increase in glycosylated
early cardiac dysfunction and a possible protective haemoglobin was associated with an 8% increased
role for insulin therapy. Diastolic dysfunction was risk of CHF .
associated with the presence of mild complications
of DM whereas systolic dysfunction was found in HEART FAILURE SCREENING IN
the presence of more severe diabetic complications. THE POPULATION WITH DIABETIC
Suggesting that the extent of systolic dysfunction MELLITUS
may depend more on the magnitude and duration
of hyperglycemia The higher morbidity and morality observed in pa-
tients with CHF and DM mandates its early identifi-
However in patients with DM the clear phelnotyp- cations in order to initiate adequate treatments and
ic distinctions noted in experimental animal models delay disease progression. Currently there is no sin-
(marked hyperinsulinemia without hyperglycemia gle imaging biomarker or histological finding pathog-
leading to LV hypertrophy and systolic dysfunction nomic for diabetic cardiomyopathy. In the studies of
and hyperglycemia without hyperinsulinemia leading left ventficular dysfunction (SOLVD) registry only
to systolic dysfunction.) have not been confirmed in approximately half of the patients with an EF <45%
patients with type I DM. Systolic dysfunction is less had CHF symptoms making it difficult to screen only
evident than in animal modes because these patients based on clinical grounds. Known independent risk
receive exogenous insulin, making them metabolical- factors for CHF in diabetic patients are older age,
ly similar to patients with type 2 DM. Longer DM duration, visceral obesity, higher glyco-
sylated haemoglobin and albuminuria making the
Response to Stress Tests use of clinical characteristics to screen CHF in diabet-
Latent LV dysfunction in diabetic heart, even in as- ic patients also difficult. Brain natriuretic peptite as a
ymptomatic subjects with normal resting LV is dimen- screening toll showed a sensitivity of 92% and spec-
sion and function, can be unmasked during exercise ificity of 72% for LV systolic dysfunction and it has
patient with type 2DM with normal myocardial func- been shown to be prognostically significant. Brain na-
tion at rest but an abnormal response to exercise triuretic peptite level might therefore be considered
stress had significantly reduced longitudinal diastolic a cost effective test with which to select patients
functional reserve index compared to those with a for echocardiographic evaluation but not sensitive
normal stress response highlighting the important enough for early detection of pre-clinical myocardial
role of myocardial diastolic relaxation in maintaining dysfunction Further more. plasma Brain natriuretic
normal myocardial function and exercise capacity peptite levels have been found significantly higher is
.These findings suggest that impaired cardiac per- CHF patients with DM than in non-diabetic patients
formance after exercise could be potential tool to at the same CHF score.
detect early contractile dysfunction in DM The underlying mechanism for the higher Brain natri-
uretic peptide level in CHF patient with DM is not clear
HEART FAILURE PROJECTIONS AND propose mechanism include an increase in brain na-
PROGNOSIS triuretic peptide formation and or a decrease in deg-
Long standing metabolic and functional alteration radation due to hyperglycemia, cardiac autonomic
ultimately lead to irreversible. Structural changes in dysfunction or higher RAAS activation compared to

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