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232 Congestive Heart Failure in Diabetic...!
How it is Different?

non-diabetic patients. Other biomarkers are of inter- hospitalization for cardiac causes, improve clinical
est class of biomarkers related to the synthesis and symptoms and cardiac function and simultaneously
are degradation of types I and III fibrillar collagens ameliorate LV remodelling.
(serum aminoterminal propeptide of type I and III ) the Ranolazine currently approved as an antianginal
most abundant collagens and in the myocardium and agent reduced the Na-dependent Calcium overload
associated with cardiac remodelling serum concen- via. Inhibition of the late sodium current (late Ina)
trations of the carboxy terminal propeptide of procol- channels and thus has been shown to improve di-
lagens type I were related to changes of LV filling astolic tone and oxygen handling during myocardial
timings in patient with early type 2 DM Upregulation ischemia.AMP-activated protein kinase is found in
of matrics metalloproteinases lead to degeneration abundance in the hart where it regulates the cellular
of the extracellular matris and replacement fibrosis response to low energy states such as hypoxia and
. Assays of these markers remain experimental and exercise to increase energy production.
need to be further validated in large trials.
Conventional echocardiographic techniques for as- CONCLUSIONS:
sessing LV hypertrophy are not specific for diabetic DM and CHF are inter related conditions DM can af-
cardiomyopathy. The development of new ultrasound fect cardiac structure and function in the absence
techniques such as echo strain imaging and the use of changes in blood pressure or CAD, a condition
of magnetic resonance imaging for the evaluation called diabetic cardiomyopathy. Insulin residence and
of strain and strain rate have shown to be effective hyperglycemia are central drivers of the initially adop-
in the identification of subclinical LV systolic and tive pathological but ultimately detrimental changes
diastolic dysfunction in asymptomatic patients with occurring in diabetic cardiomyopathy. Alterations in
DM and normal EF. Recently the European society substrate utilization and mitochondrial dysfunction
of cardiology has suggested criteria for the diagno- seem to be early and key alterations in diabetic car-
sis of diastolic dysfunction. but there are no specific diomyopathy. In later stages concomitant CV risk
guidelines for CHF screening in the asymptomatic factors such as hypertension, dyslipidemia neuro-
population with DM and recommendations for CHF hormonal activation renal impairment and CAD may
screening are warrented. A combination of clinical further compromise cardiac dysfunction.
characteristics potential symptoms biomarkers of
cardiac functions and new diagnostic technique may Treatment of concomitant DM and CHF is challeng-
provide potential tools to identify diabetes subject at ing since many contemporaries therapics used for
increased risk of developing CHF. The current ap- DM are contraindicated or limited by comorbidities
proach to the classification of CHF emphasizes at tge such as renal dysfunction. Sub-group analysis of re-
development and progression of the disease from a cent trials conducted in hospitalized.
Stage A Through D. Patients with DM who do not CHF patients with DM showed a different response
yet demonstrate LV dysfunction would be considered to standard medication being more prone to devel-
stage A . As patients move through stages B-D, they op side effects compared to patients with the same
develop structural changes symptoms and then re- degree of CHF but without DM.
fractory and stage disease.
The growing two-way co-association between heart
Importantly CHF patients who have not been diag- failure and diabetes mellitus request that cardiolo-
nosed with DM should be screened for early detec- gists and others caring for patients with heart failure
tion of glucose intolerance or DM. must be increasingly familiar with the management
of diabetic mellitus.
AREAS FOR FUTURE RESEARCH

Therapies targeted to address the specific patho- References
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DM are needed specific data on this population are al.Euroheart failure survey II(EHFS II) a survey on hospitalized acute heart
lacking currently. An ideal approach would be to failure patient: Description of population. Eur Heart J 2006; 27:2725-36.
modulate myocardial substrate utilization (168) from 2. Sarma S.Mentz RJ, Kwasny MJ, Fought AJ, Huffman M, Subacius H, et
FFA to glucose oxidation to achieve a more efficient al; on behalf of the EVEREST investigators. Association between diabetic
cardiac energy population. mellitus and post-discharge outcomes in patients hospitalized with heart
failure: findings from the EVEREST trial. Eur J Heart Fail 2013; 15 :
Recent meta analysis has shows that additional 194-202
use of trimetazidine in CHF spatient may decrease 3. Thrainsdottir IS, Aspelunt T, Thorgeirsson G, Gutnason V, Hardar-
sonT,Malmberg K et al . The association between glucose abnormalities

GCDC 2017