Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging

Thomas H Marwick, Alessia Gimelli, Sven Plein, Jeroen J Bax, Phillippe Charron, Victoria Delgado, Erwan Donal, Patrizio Lancellotti, Eylem Levelt, Pal Maurovich-Horvat, Stefan Neubauer, Gianluca Pontone, Antti Saraste, Bernard Cosyns, Thor Edvardsen, Bogdan A Popescu, Maurizio Galderisi, Genevieve Derumeaux, Magnus Bäck, Philippe B BertrandMarc Dweck, Niall Keenan, Julien Magne, Danilo Neglia, Ivan Stankovic

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.

Original languageEnglish
Pages (from-to)e62-e84
Number of pages23
JournalEuropean Heart Journal - Cardiovascular Imaging
Volume23
Issue number2
Early online date5 Nov 2021
DOIs
Publication statusPublished - 1 Feb 2022

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.

Keywords

  • diabetes
  • diabetic cardiomyopathy
  • heart failure
  • mechanisms
  • screening

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