Table 1: DCM classification (adapted from Maisch et al., 2011).

Classification landmarksStage 1 DCM (diastolic dysfunction, hypertrophy)Stage 2 DCM systolic dysfunction and dilatationStage 3 DCM systolic dysfunction, dilatation, associated HTA Stage 4 DCM including all confounders, also CAD

Correspondence in NYHA classificationAsymptomaticNYHA IINYHA II-IIINYHA II–IV
Metabolic statusImpaired glucose tolerance; metabolic syndromeChronic hyperglycemiaInsulin resistance; DM with microangiopathic complicationsDM with micro- and macroangiopathic complications
Echocardiographic features ± coronarographyIncreased LV mass, diastolic dysfunction, decreased tissue velocities, normal EFIncreased LV mass and wall thickness, diastolic and systolic dysfunction (EF < 50%) mild cavity dilatationDiastolic dysfunction and mild systolic dysfunction cavity dilatationModerate-severe systolic dysfunction cavity dilatation associated coronary artery disease
Other DM-related associated comorbiditiesMicroangiopathic complications; HTAMacroangiopathic complications, including CAD
Serological markers to be monitored periodically regarding glycemic control, heart failure, and myocardial necrosisNTproBNP, MMP-3, and osteopontin (according to van der Leeuw et al. 2016) Glc, lipid profile, HbA1CMMP-3 and osteopontin (according to van der Leeuw et al. 2016) Glc, lipid profile, HbA1C, NTproBNP, BNPMMP-3 and osteopontin (according to van der Leeuw et al. 2016) Glc, lipid profile, HbA1C, NTproBNP, BNP troponins increased in concurrent ischemiaGlc, lipid profile, HbA1C, NTproBNP, BNP troponins increased in myocardial infarction or severe heart failure

DDM: diabetes mellitus; EF: ejection fraction; Glc: glucose level;
HTA: arterial hypertension; LV: left ventricle; and MMP-3: metalloproteinase 3.