Diabetic Cardiomyopathy: Definition, Diagnosis, and Therapeutic Implications.

Diabeticcardiomyopathyreferstoacardiacdysfunctionobservedinpatientswithdiabetesthatoc- curs in absence of other cardiovascular disease, such as coronary artery disease, hypertension, valvular, and congenital heart disease. The main metabolic abnormalities promoting cardiac dysfunction are the resistance to the meta- bolic actions of insulin in heart tissue, compensatory hyperinsulinemia, and the progression of hyperglycemia. Two stages of diabetic cardiomyopathy are described: an early stage characterized by left ventric- ular hypertrophy and impaired diastolic function, and a late stage characterized by cardiac fibrosis and systolic dysfunction. The occurrence of HF in patients affected by DM significantly impacts on quality of life, manifesta- tion of new symptoms and worsening of existing symptoms, and on long-term prognosis. Notargettreatmentshavebeentestedindiabeticcardiomyopathy,thusclinicaltrialsareneededto define the role of available HF therapies or to find new therapeutic targets for this clinical condition.