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Diabetes aktuell 2012; 10(2): 61-67
DOI: 10.1055/s-0032-1313921
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© Georg Thieme Verlag Stuttgart · New York

Die Schwester sagt ”Guten Appetit“, und was passiert mit Ihrem Herz? – Diabetes und Herzfunktion – Prävention von Herzversagen (nach Myokardinfarkt)

Diabetes and cardiac function – prevention of heart failure
Helene von Bibra
1   Klinik für Endokrinologie, Diabetes und Angiologie, Klinikum Bogenhausen (Chefarzt: Prof. Dr. Petra-Maria Schumm-Draeger)
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Publication History

Publication Date:
03 May 2012 (online)

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Die ungute Prognose für diabetische Patienten mit Herzversagen nach Herzinfarkt ist auf multiple Faktoren zurückzuführen, unter denen von besonderer Bedeutung der metabolische Einfluss von Insulinresistenz und Hyperglykämie auf die Regulierung der mikrovaskulären Myokardperfusion und auf die Energieherstellung im Kardiomyozyten ist. Gerade weil es sich hier um interdisziplinäre Mechanismen der Fachgebiete Endokrinologie und Kardiologie handelt, wächst der Bekanntheitsgrad dieser Interaktionen im Myokard nur langsam und das gesundheitsförderliche Potenzial im Wissen um das Phänomen Insulinresistenz wird nicht ausgeschöpft. Dabei sind aber viele Patienten mit Diabetes mellitus, dem metabolischen Syndrom und der zugrunde liegenden Insulinresistenz zunehmend von kardialer diastolischer Dysfunktion und reduzierter Belastbarkeit betroffen und somit Risikopatienten für Herzinsuffizienz. Diese Übersichtsarbeit befasst sich mit der relevanten Pathophysiologie, Diagnostik und Therapie bei Diabetes/metabolischem Syndrom und Herzversagen (nach Myokardinfarkt) und diskutiert neue Ansichtweisen und Strategien, die für die Zukunft aussichtsreich erscheinen und weiterer Abklärung bedürfen.

The poor prognosis associated with heart failure in patients with diabetes after myocardial infarction is likely attributable to many factors, important among which is the metabolic impact from insulin resistance and hyperglycemia on the regulation of microvascular perfusion and energy generation in the cardiac myocyte. The interdisciplinary nature of these mechanisms – linking cardiology and endocrinology – is likely attributable to the rather slow rate of acknowledgement and the inadequate use of our knowledge about insulin resistance for increasing the potential of public health. However, many patients with diabetes mellitus, the metabolic syndrome, and the underlying insulin resistance are increasingly associated with diastolic dysfunction and reduced stress tolerance and, accordingly, at risk for heart failure. This review summarizes pathophysiologic, diagnostic, and therapeutic data related to diabetes and heart failure (in acute myocardial infarction) and discusses novel perceptions and strategies that hold promise for the future and deserve further investigation.

Key words

Diastolic dysfunction - tissue doppler - myocardial contrast echocardiography - type 2 diabetes - insulin resistance - carbohydrate restriction
 

  • Literatur

  • 1 von Bibra H, St John Sutton M. Diastolic dysfunction in diabetes and the metabolic syndrome: promising potential for diagnosis and prognosis. Diabetologia 2010; 53: 1033-1045
    CrossrefGoogle Scholar
  • 2 Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis and treatment. Eur Heart J 2011; 32: 670-679
    CrossrefGoogle Scholar
  • 3 Hansen A, Johansson BL, Wahren J et al. Beneficial effects of C-peptide on myocardial function and perfusion in patients with type 1 diabetes. Diabetes 2002; 51: 3077-3082
    CrossrefGoogle Scholar
  • 4 von Bibra H, Thrainsdottir IS, Hansen A et al. Tissue Doppler imaging for the detection and quantitation of myocardial dysfunction in patients with type 2 diabetes mellitus: A methodological study. Diabetes Vasc Dis Res 2005; 2: 483-487
    Google Scholar
  • 5 Senior R, Becher H, Monaghan M et al. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. Eur J Echocardiogr 2009; 10: 194-212
    Google Scholar
  • 6 Scognamiglio R, Negut C, De Kreutzenberg SV et al. Postprandial myocardial perfusion in healthy subjects and in type 2 diabetic patients. Circulation 2005; 112: 179-184
    CrossrefGoogle Scholar
  • 7 Dounis V, Siegmund T, Jensen J et al. Global myocardial perfusion and diastolic function are impaired to a similar extent in patients with type 2 diabetes mellitus and in patients with CAD – evaluation by contrast echocardiography and pulsed tissue Doppler. Diabetologia 2006; 49: 2729-2740
    CrossrefGoogle Scholar
  • 8 von Bibra H, Hansen A, Dounis V et al. Insulin based improved metabolic control augments myocardial diastolic function and perfusion in patients with type 2 diabetes mellitus. Heart 2004; 90: 1483-1484
    CrossrefGoogle Scholar
  • 9 Scognamiglio R, Negut C, De Kreutzenberg S et al. Effects of different insulin regimens on postprandial myocardial perfusion defects in type 2 diabetic patients. Diabetes Care 2006; 29: 95-100
    CrossrefGoogle Scholar
  • 10 Witteles RM, Fowler MB. Insulin-resistant cardiomyopathy. J Am Coll Cardiol 2008; 51: 93-102
    CrossrefGoogle Scholar
  • 11 Boudina S, Dale Abel E. Diabetic cardiomyopathy revisited. Circulation 2007; 115: 3213-3223
    CrossrefPubMedGoogle Scholar
  • 12 Falk Peterson K, Dufour S, Savage DB et al. The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome. PNAS 2007; 104: 12587-12594
    CrossrefGoogle Scholar
  • 13 Pfützner A, Forst T. Elevated intact proinsulin levels are indicative of beta-cell dysfunction, insulin resistance and cardiovascular risk: Impact of the antidiabetic agent pioglitazone. J Diabetes Sci Technol 2011; 5: 784-793
    Google Scholar
  • 14 Paulus WJ, Tschöpe C, Rusconi C et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28: 2539-2550
    CrossrefGoogle Scholar
  • 15 Villanueva FS. Myocardial perfusion imaging using ultrasound contrast agents – now or never?. J Am Coll Cardiol Cardiovascular Imaging 2010; 3: 944-946
    Google Scholar
  • 16 Marantz PR, Bird ED, Alderman MH. A call for higher standards of evidence for dietary guidelines. Am J Prev Med 2008; 34: 234-240
    CrossrefGoogle Scholar
  • 17 Accurso A, Bernstein RK, Dahlqvist A et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab 2008; 5: 9-17
    CrossrefGoogle Scholar
  • 18 von Bibra H, St John Sutton M. Impact of diabetes on postinfarction heart failure and left ventricular remodeling. Curr Heart Fail Rep 2011; 8: 242-251
    CrossrefGoogle Scholar
  • 19 American Diabetes Association. Nutrition recommendations and interventions for diabetes. Diabetes Care (Suppl. 01) 2008; 31: 61-78
    CrossrefPubMedGoogle Scholar
  • 20 De Caterina R, Madonna R, Sourij H et al. Glycemic control in acute coronary syndromes: prognostic value and therapeutic options. Eur Heart J 2010; 31: 1557-1564
    CrossrefGoogle Scholar