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Abstract
The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6 % in control populations (Bauters C et al, 2003).
Epidemiological evidence in the community underscores the prevalence of the left ventricular systolic dysfunction in type 2 diabetic patients as 2- fold with respect to non-diabetic ones, with half of them completely asymptomatic. Diastolic dysfunction in type 2 diabetic hearts in comparison with non-diabetic is even more frequent (Tarantini L et al, 2004).
Various mechanisms may link type 2 diabetes mellitus to heart failure: First; associated comorbidities such as hypertension may play a role; second; type 2 diabetes accelerates the development of coronary atherosclerosis; third; experimental and clinical studies support the existence of a specific diabetic cardiomyopathy.
In these patients the diabetic metabolic derangements, together with early activation of sympathetic nervous system, induce a decrease of myocardial function. The activation of renin-angotensin system results in an unfavorable cardiac remodeling. The progression from myocardial damage to overt dysfunction and heart failure is often asymptomatic for a long time and frequently undiagnosed and untreated.
There are still many unresolved issues in the assessment of myocardial function through the progressive stages of diabetic heart disease and myocardial damage. During the past years, with rapidly