Dijabetička kardiomiopatija

Autor: Jasna Cerkez Habek, Jozica Sikic
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Cardiologia Croatica
Volume 8
Issue 12
ISSN: 1848-5448
1848-543X
Popis: Dijabetička kardiomiopatija, koronarna bolest srca (KBS) i autonomna neuropatija su bolesti koje povećavaju morbiditet i mortalitet pacijenta sa šećernom bolesti. Dijabetičku kardiomiopatiju definiraju asimptomatske, progresivne promjene u strukturi, a potom i funkciji miokarda koje dovode do njegovog remodeliranja, a nisu vezane uz KBS, arterijsku hipertenziju ili valvularnu patologiju. Etiologija navedenih promjena je multifaktorska i posljedica je metaboličkog disbalansa koji je vezan prvenstveno uz dugotrajnu hiperglikemiju. Nažalost, dijabetička kardiomiopatija usprkos svog značaja ostaje često neprepoznata komplikacija višegodišnjeg dijabetesa koja značajno povećava smrtnost. Klinička slika može varirati od subkliničke ventrikularne disfunkcije, do razvijene kliničke slike srčanog zatajivanja. Bolesnici s razvijenom dijabetičkom kardiomiopatijom imaju dva do pet puta veći rizik od srčanog zatajivanja. Ehokardiografija je standard u otkivanju kardiomiopatije, u početnoj fazi bolesti nalazi se oštećenje dijastoličke funkcije različitog stupnja, a tek u terminalnoj fazi kardiomiopatije se verificira i smanjenje sistoličke funkcije lijeve klijetke. Rjeđe se dijagnoza postavlja uporabom magnetske rezonance, a u istraživanjima su i novi biomarkeri koji bi olakašli dijagnostiku u asimptiomatskih bolesnika. Liječenje dijabetičke kardiomiopatije podrazumijeva promjene u životnom stilu, bolju regulaciju glikemije, lipidnog profila i arteirjske hipertenzije uz redovitu fizičku aktivnost, a terapija srčanog zatajivanja se ne razlikuje se od bolesnika bez dijabetesa. Nažalost, strukturalne i morfološke promjene miokarda započinju već u pre-dijabetičkoj fazi, stoga se očekuje da će nova istraživanja indentificirati biomarkere koji mogu detektirati asimptomatske bolesnike uz pronalazak strategije koja bi navedene promjene učinila reverzibilnima.
Diabetic cardiomyopathy, coronary heart disease (CHD) and autonomic neuropathy are the diseases that increase morbidity and mortality in patients with diabetes mellitus. Diabetic cardiomyopathy is characterized by asymptomatic, progressive changes in the structure, and also in the myocardial function that lead to myocardial remodeling, and are not related to CHD, hypertension or valvular pathology. The etiology of these changes is multifactorial and is the consequence of metabolic imbalance that is primarily related to long-term hyperglycemia. Unfortunately, diabetic cardiomyopathy, despite its significance often remains an unrecognized complication of diabetes that patients suffer from for several years that however, greatly increases mortality. The clinical symptoms may vary from subclinical ventricular dysfunction to advanced clinical symptoms of heart failure. Patients with advanced diabetic cardiomyopathy have two to five time higher risk of heart failure. Echocardiography is the standard in detecting cardiomyopathies, in the initial stage of the disease there is an impairment of the diastolic function of a different degree, and the reduction of systolic left ventricular function is verified only in the end-stage of cardiomyopathy. Rarely, the diagnosis is made by using magnetic resonance imaging, and reserchers have found new biomarkers that would facilitate the diagnostics in asymptomatic patients. The treatment of diabetic cardiomyopathy involves changes in lifestyle, better glycemic control, lipid profile and hypertension accompanied by regular physical activity, whereas the therapy of heart failure does not differ from the therapy administered to the patients without diabetes. Unfortunately, the myocardial structural and morphological changes start already in the pre-diabetic stage, therefore, the new trials are expected to identify biomarkers that can detect asymptomatic patients thereby finding a strategy that would make the above changes reversible.
Databáze: OpenAIRE
Externí odkaz: