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Minerva Cardioangiologica 2021 Jan 11

DOI: 10.23736/S0026-4725.20.05454-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Diabetic cardiomyopathy and inflammation: development of hostile microenvironment resulting in cardiac damage

Edoardo ELIA 1, Stefano MINISTRINI 2, Federico CARBONE 3, 4, Fabrizio MONTECUCCO 4, 5

1 Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy; 2 Department of Medicine, Internal Medicine, Università degli Studi di Perugia, Perugia, Italy; 3 Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy; 4 IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Genoa, Italy; 5 Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), First Clinic of Internal Medicine, University of Genoa, Genoa, Italy


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Diabetes mellitus is emerging as a major risk factor for heart failure. Diabetic cardiomyopathy is defined as a myocardial dysfunction that is not caused by underlying hypertension or coronary artery disease. Studies about clinical features, natural history and outcomes of the disease are few and often conflicting, because a universally accepted operative definition of diabetic cardiomyopathy is still lacking. Hyperglycemia and related metabolic and endocrine disorders are the triggering factors of myocardial damage in diabetic cardiomyopathy through multiple mechanisms. Among these mechanisms, inflammation has a relevant role, similar to other chronic myocardial disease, such as hypertensive or ischemic heart disease. A balance between inflammatory damage and healing processes is fundamental for homeostasis of myocardial tissue, whereas diabetes mellitus produces an imbalance, promoting inflammation and delaying healing. Therefore, diabetes-related chronic inflammatory state can produce a progressive qualitative deterioration of myocardial tissue, which reflects on progressive left ventricular functional impairment, which can be either diastolic, with prevalent myocardial hypertrophy, or systolic, with prevalent myocardial fibrosis. The aim of this narrative review is to summarize the existing evidence about the role of inflammation in diabetic cardiomyopathy onset and development. Ultimately, potential pharmacological strategies targeting inflammatory response will be reviewed and discussed.


KEY WORDS: Diabetes mellitus; Myocardial dysfunction; Heart failure; Immune metabolism; Diabetic cardiomyopathy

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