Distinct Myocardial Targets for Diabetes Therapy in Heart Failure With Preserved or Reduced Ejection Fraction

JACC. Heart Failure
Walter J Paulus, Elisa Dal Canto

Abstract

Noncardiac comorbidities such as diabetes mellitus (DM) have different outcomes in heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). These different outcomes are the result of distinct myocardial effects of DM on HFpEF and HFrEF, which relate to different mechanisms driving myocardial remodeling in each heart failure phenotype. Myocardial remodeling is driven by microvascular endothelial inflammation in HFpEF and by cardiomyocyte cell death in HFrEF. Evidence consists of: different biomarker profiles, in which inflammatory markers are prominent in HFpEF and markers of myocardial injury or wall stress are prominent in HFrEF; reduced coronary flow reserve with microvascular rarefaction in HFpEF; and upregulation of free radical-producing enzymes in endothelial cells in HFpEF and in cardiomyocytes in HFrEF. As biopsies from patients with diabetic cardiomyopathy reveal, DM affects failing myocardium by phenotype-specific mechanisms. In HFpEF, DM mainly increases cardiomyocyte hypertrophy and stiffness, probably because of hyperinsulinemia and microvascular endothelial inflammation. In HFrEF, DM augments replacement fibrosis because of cardiomyocyte cell death ...Continue Reading

Citations

Mar 9, 2018·European Journal of Heart Failure·Angelo Avogaro, Gian Paolo Fadini
Jul 14, 2018·American Journal of Physiology. Heart and Circulatory Physiology·Linda AlexNikolaos G Frangogiannis
Nov 10, 2018·Future Cardiology·Robert J Henning
Apr 12, 2019·International Heart Journal·Zhi-Dong GeZhengyuan Xia
May 9, 2019·International Journal of Molecular Sciences·Joseph Pierre AboumsallemBart De Geest
Oct 15, 2018·Journal of Molecular Histology·Ahmed A M Abdel-Hamid, Alaa El-Din L Firgany
Jul 5, 2019·International Journal of Molecular Sciences·Isabella EvangelistaAlberto Palazzuoli
Jul 25, 2019·Frontiers in Endocrinology·Ariane A SickingheElise L Kessler
Nov 15, 2019·European Journal of Preventive Cardiology·Elisa Dal CantoJoline Wj Beulens
May 21, 2020·Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders·Alexander E Berezin, Alexander A Berezin
Feb 12, 2020·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Jessica ReidRebecca F Goldfaden
Jun 1, 2021·Journal of the American Heart Association·Rohan Samson, Thierry H Le Jemtel
Jul 20, 2021·Diabetes Research and Clinical Practice·Alfredo CaturanoFerdinando Carlo Sasso
Aug 13, 2021·Aging Cell·Thassio MesquitaAhmed Ibrahim

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle, that can lead to muscular or electrical dysfunction of the heart. It is often an irreversible disease that is associated with a poor prognosis. There are different causes and classifications of cardiomyopathies. Here are the latest discoveries pertaining to this disease.