Ventricular dysfunction in early diabetic heart disease: detection, mechanisms and significance

Gerald Watts, T.H. Marwick

Research output: Contribution to journalReview article

37 Citations (Scopus)

Abstract

The detection of preclinical heart disease is a new direction in diabetes care. This comment describes the study by Vinereanu and co-workers in this issue of Clinical Science in which tissue Doppler echocardiography has been employed to demonstrate subtle systolic and diastolic dysfunction in Type 11 diabetic patients who had normal global systolic function and were free of coronary artery disease. The aetiology of early ventricular dysfunction in diabetes relates to complex intramyocardial and extramyocardial mechanisms. The initiating event may be due to insulin resistance, and involves abnormal myocardial substrate utilization and uncoupling of mitochondrial oxidative phosphorylation. Dysglycaemia plays an important role via the effects of oxidative stress, protein kinase C activation and advanced glycosylation end-products on inflammatory signalling, collagen metabolism and fibrosis. Extramyocardial mechanisms involve peripheral endothelial dysfunction, arterial stiffening and autonomic neuropathy. The clinical significance of the ventricular abnormalities described is unknown. Confirmation of their prognostic importance for cardiac disease in diabetes would justify routine screening for presymptomatic ventricular dysfunction, as well as clinical trials of novel agents for correcting causal mechanisms. These considerations could also have implications for patients with obesity and the metabolic syndrome.
Original languageEnglish
Pages (from-to)537-540
JournalClinical Science
Volume105
DOIs
Publication statusPublished - 2003

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Ventricular Dysfunction
Heart Diseases
Advanced Glycosylation End Products
Doppler Echocardiography
Oxidative Phosphorylation
Heat-Shock Proteins
Protein Kinase C
Insulin Resistance
Coronary Artery Disease
Oxidative Stress
Fibrosis
Collagen
Obesity
Clinical Trials
Direction compound

Cite this

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Ventricular dysfunction in early diabetic heart disease: detection, mechanisms and significance. / Watts, Gerald; Marwick, T.H.

In: Clinical Science, Vol. 105, 2003, p. 537-540.

Research output: Contribution to journalReview article

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AU - Marwick, T.H.

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