[Diabetic cardiomyopathy]

In the last decades, due to the growing number of new cases of diabetes and its cardiovascular complications, much attention has been paid to diabetic cardiomyopathy. The studies on the etiology of this condition have confirmed the role of advanced glycation end products, lipoprotein a Lp(a), apolipoprotein B (apo B) and the changes in the intracellular calcium levels. An insight in the natural history of left ventricular diastolic and systolic dysfunction in diabetes has been made possible thanks to the widespread availability of echocardiography. Diastolic dysfunction, characteristic of diabetes, precedes the onset of systolic dysfunction, which reveals at a later stage, first as exercise-induced abnormalities. The influence of diabetes on morphology of the heart manifests as hypertrophy of the left ventricle, especially in non-insulin-dependent diabetes and enlargement of the left atrial chamber. The results of the studies are not decisive as to the possible correlation between the severity of the diastolic dysfunction and the duration of diabetes or the quality of metabolic control. The presence of significant coexisting conditions, including hypertension and the complications of diabetes such as autonomic neuropathy is associated with more pronounced symptoms of diastolic dysfunction and higher values of corrected QT interval and dispersion which are considered to be the most important predictors of mortality in diabetic patients.