Diabetic Cardiomyopathy: Current Approach and Potential Diagnostic and Therapeutic Targets

Table 1

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

Classification landmarks	Stage 1 DCM (diastolic dysfunction, hypertrophy)	Stage 2 DCM systolic dysfunction and dilatation	Stage 3 DCM systolic dysfunction, dilatation, associated HTA	Stage 4 DCM including all confounders, also CAD
Correspondence in NYHA classification	Asymptomatic	NYHA II	NYHA II-III	NYHA II–IV
Metabolic status	Impaired glucose tolerance; metabolic syndrome	Chronic hyperglycemia	Insulin resistance; DM with microangiopathic complications	DM with micro- and macroangiopathic complications
Echocardiographic features ± coronarography	Increased LV mass, diastolic dysfunction, decreased tissue velocities, normal EF	Increased LV mass and wall thickness, diastolic and systolic dysfunction (EF < 50%) mild cavity dilatation	Diastolic dysfunction and mild systolic dysfunction cavity dilatation	Moderate-severe systolic dysfunction cavity dilatation associated coronary artery disease
Other DM-related associated comorbidities			Microangiopathic complications; HTA	Macroangiopathic complications, including CAD
Serological markers to be monitored periodically regarding glycemic control, heart failure, and myocardial necrosis	NTproBNP, MMP-3, and osteopontin (according to van der Leeuw et al. 2016) Glc, lipid profile, HbA1C	MMP-3 and osteopontin (according to van der Leeuw et al. 2016) Glc, lipid profile, HbA1C, NTproBNP, BNP	MMP-3 and osteopontin (according to van der Leeuw et al. 2016) Glc, lipid profile, HbA1C, NTproBNP, BNP troponins increased in concurrent ischemia	Glc, 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.