Diabetic cardiomyopathy: diagnostic biomarkers

Abstract

The review provides a classification of biomarkers of the cardiovascular system diseases, biological markers that have found application in a cardiological clinic, biomarkers of heart failure, modern recommendations on the use of biomarkers for the diagnosis and treatment of acute and chronic heart failure. Special attention is paid to the importance of myocardial pro-hypertrophic biomarkers (atrial natriuretic peptide, brain natriuretic peptide, N-amino terminal fragment of the prohormone B-type natriuretic peptide, cardiotrophin-1); biomarkers of myocardial contractile dysfunction (troponins); pro-steatosis biomarkers of diabetic cardiomyopathy (human heart-type fatty acid binding protein); the value of epicardial adipose tissue; extracellular matrix remodeling markers (matrix metalloproteinases); fibrotic and inflammatory biomarkers (transforming growth factor beta, galectin-3, stimulating growth factor ST2). However, the use of biomarkers to identify left ventricular dysfunction remains a debatable issue. Natriuretic peptides are released in response to the progression of stress-induced cardiomyopathy, which is rare in patients with subclinical dysfunction and left ventricular hypertrophy. Obesity is associated with lower levels of natriuretic peptides, which may impair the sensitivity of the test. However, screening based on natriuretic peptide is effective for detecting moderate diastolic dysfunction. Other potential biomarkers of myocardial dysfunction in diabetes have also been reported, including circulating microribonucleic acids and glucose metabolites (eg, O-GlcNAc) found in circulating erythrocytes. However, a clear consensus has not yet been reached on the clinical role of any of these possible biomarkers.