糖尿病心肌病.ppt

Clinicoepidemiologic studies Definitions Diabetic cardiomyopathy refers to a disease process which affects the myocardium in diabetic patients causing a wide range of structural abnormalities eventually leading to LVH and diastolic and systolic dysfunction or a combination of these 糖尿病心肌病 是指糖尿病微血管病变所引起心肌结构异常、心室肥厚和舒张/收缩功能不全的心肌病 Diabetic cardiomyopathy— Pathology Pathology Structural changes-LVH Parasternal short-axis view in systole (a) and diastole (b) and parasternal long-axis view (c) in a patient with severe concentric LVH Salient features Preclinical cardiac dysfunction Prolonged pre-ejection period (PEP) Shortened LV ejection time (LVET) Increase in PEP/LVET ratio Prolonged isovolumic relaxation Prolongation of early diastolic filling Increased LVEDP and depressed end diastolic volume Latent cardiac dysfunction – failure of ejection fraction to rise with exercise Functional changes Diastolic dysfunction refers to echocardiographic features of an abnormal LV relaxation pattern without clinical HF Diastolic HF refers to a clinical syndrome of HF with a preserved LV ejection fraction Systolic dysfunctionsystolic dysfunction occurs late in diabetic cardiomyopathy, often when patients have already developed significant diastolic dysfunction Prognosis Diabetic cardiomyopathy— Pathogenesis Pathogenesis Factors contributing to diabetic cardiomyopathy Diabetic autonomic neuropathy Microangiopathy leading to tissue anoxia and fibrosis Metabolic derangements Growth hormone Molecular basis (1) Cardiac-specific overexpression of the kd-PFK-2 transgene Fru-2,6-P2 is reduced in transgenic heart Insulin-stimulated phosphorylation of Akt in FVB and Mb7 hearts Glycolysis is important to cardiac metabolism and reduced glycolysis may contribute to diabetic cardiomyopathy. Potential mechanisms linking diabetes mellitus to heart failure Diagnosis Diabetics with LVH and diastolic and systolic dysfunction or a combination of these，but no CAD, HT or VHD R