Diabetic cardiomyopathy.

Although the pathogenesis of diabetic cardiomyopathy is poorly understood, recent evidence implicates perturbations in cardiac energy metabolism. Whereas mitochondrial fatty acid oxidation is the chief energy source for the normal postnatal mammalian heart, the relative contribution of glucose utilization pathways is significant, allowing the plasticity necessary for steady ATP production in the context of diverse physiologic and dietary conditions. Because of the importance of insulin in the regulation of myocardial metabolism, chronic insulin deficiency or resistance results in a marked reduction in cardiac glucose utilization such that the heart relies almost exclusively on fatty acids to generate energy. High rates of fatty acid utilization in the diabetic heart could lead to functional derangements related to accumulation of lipid intermediates, excessive oxygen consumption.... Chronic derangements in myocardial cell metabolism, as well as impairment of various intracellular signalling pathways, may therefore have maladaptive consequences, including functional abnormalities.