Summary
The pathogenesis of diabetic cardiomyopathy is unknown. The synergistic, or enhanced, effect of hypertension on pathological changes in the heart of diabetic patients has been highly suspected. The purpose of this study was to evaluate the myocardial changes related to diabetes mellitus with and without hypertension, using biopsy specimens. We examined the ultrastructural changes in biopsy specimens of the endomyocardium obtained from 25 patients. They were divided into four groups: controls without hypertension or diabetes mellitus (n=6), and patient with hypertension (n=3), diabetes mellitus (n=8), and diabetes with hypertension (n=8). The diabetic patients showed nearly normal or mildly depressed systolic left ventricular function. Ultrastructural pictures were analyzed for thickening of the capillary basement membrane, presence of toluidine blue-positive materials (i.e., materials showing metachromasia) in the myocytes, size of myocytes, and interstitial fibrosis. The thickening of the capillary basement membrane, the accumulation of toluidine blue-positive materials, and interstitial fibrosis were all significantly greater in the patients with diabetes mellitus compared to the control subjects. The myocytes tended to be small (cell atrophy) in the diabetes group. Although these pathological changes in the heart were characteristic of diabetic patients, irrespective of the presence or absence of hypertension, the presence of hypertension increased the pathological changes of myocardial cells as well as abnormality in the capillary vessels in patients with diabetes mellitus. Alterations in the myocardial cells and capillaries, caused by diabetes mellitus, may lead to myocardial cell injury and interstitial fibrosis and, ultimately, to ventricular systolic and diastolic dysfunction, especially when the diabetes is accompanied by hypertension.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Blunmental HT, Alex M, Goldenberg S (1960) A study of lesions of intramural coronary by branches in diabetes mellitus. Arch Pathol 70:27–42
Rubler S, Dlugash J, Yuccoglu YZ, Kumral T, Branwood AW, Grishman AW (1972) New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30:595–602
Hamby RI, Zoneraich S, Sherman L (1974) Diabetic cardiomyopathy. JAMA 299:1749–1754
Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 34:29–34
Ledet T (1968) Histological and histochemical changes in the coronary arteries of old diabetic patients. Diabetologia 4:268
Regan TJ, Lyons MM, Levinson GE, Oldewurtel HA, Ahmad MR, Haider B (1977) Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 60:885–899
Regan TJ, Ettinger PO, Khan MI, Jesrani MU, Lyons MM, Oldewurtel HA, Weber M (1974) Altered myocardial function without ischemia in dogs. Circ Res 35:222–237
Haider B, Ahmed SS, Moschos CB, Oldewurtel HA, Regan TJ (1977) Myocardial function and coronary blood flow response to acute ischemia in chronic canine diabetes. Circ Res 40:577–583
Factor SM, Minase T, Sonnenblick AH (1980) Clinical and morphological features of human hypertensive-diabetic cardiomyopathy. Am Heart J 99:446–458
Factor SM, Minase T, Bhan R, Wolinski H, Sonnenblick EH (1981) Hypertensive-diabetic cardiomyopathy in the rat. An experimental model of human disease. Am J Pathol 102:219–317
Factor SM, Okun EM, Minase T (1980) Capillary microaneurysms in the human diabetic heart. N Engl J Med 302:384–388
van Hoeven KH, Factor SM (1990) A comparison of the pathological spectrum of hypertensive, diabetic, and hypertensive-diabetic heart disease. Circulation 82:848–855
Fischer M, Wiest G, Tekesin I, Amann K, Mann J, Hasslacher C, Derks H, Mall G (1992) Effects of combined renovascular hypertension and diabetes mellitus on myocardial cells, non-vascular interstitium and capillaries: a stereological study on rat hearts. Virchows Arch A Pathol Anat 420:499–506
Coughlin SS, Pearle DL, Baughman KL, Wasserman A, Tefft MC (1994) Diabetes mellitus and risk of idiopathic dilated cardiomyopathy. The Washington DC Dilated Cardiomyopathy Study. Ann Epidemiol 4:67–74
Siperstein RH, Unger RH, Madison LL (1968) Studies of muscle capillary basement membrane in normal subjects. J Clin Invest 47:1974–1999
Sutton MG, Lie JT, Anderson KR, O’Brien PC, Frye RL (1980) Histopathological specificity of hypertrophic obstructive cardiomyopathy. Br Heart J 44:433–443
Noda S (1980) Histopathology of endomyocardial biopsies from patients with idiopathic cardiomyopathy; quantitative evaluation based on multivariate statistical analysis. Jpn Circ J 44:95–116
Van Noorden S, Olsen EGJ, Pearse GE (1971) Hypertrophic obstructive cardiomyopathy, a histological, histochemical, and ultrastructural study of biopsy material. Cardiovasc Res 5:118–125
Agenaes O, Moe H (1961) Light- and electron microscopic study of skin of capillaries of diabetics. Diabetes 10:253–259
Beisswenger PJ, Sipro RG (1970) Studies on the human glomerular basement membrane. Diabetes 22:180–192
Rudolf V (1974) Basal lamina layering in diabetes mellitus. Diabetes 23:94–104
Silver MD, Huckell VF, Lorber M (1977) Basement membranes of small cardiac vessels in patients with diabetes and myxoedema. Pathology 9:213–220
Fischer VW, Hendrick BB, Leskiw ML (1979) Capillary basal laminar thickness in human myocardium. Diabetes 28:718–719
Tilton RG, Chang K, Nyengard TR, Enden M, Ido Y, Willanson JR (1995) Inhibition of sorbital dehydrogenase. Diabetes 44:234–242
Kenneth HG, O’Sullivan JB (1988) The sorbitol pathway. Diabetes 17:239–243
Chillan WM, Eastham CL, Marcus ML (1986) Microvascular distribution of coronary vascular resistance in the beating left ventricle. Am J Physiol 251:779–788
Chillan WM, Layne SM, Klansner EL, Eastham CL, Marcus ML (1989) Redistribution of coronary microvascular resistance produced by dipyridamole. Am J Physiol 256:383–390
Fein FS, Capasso JM, Aronson RS, Cho S, Nordin C, Miller-Green B, Sonnenblick EH, Factor SM (1984) Combined renovascular hypertension and diabetes in rats. A new preparation of congestive cardiomyopathy. Circulation 70:318–330
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kawaguchi, M., Techigawara, M., Ishihata, T. et al. A comparison of ultrastructural changes on endomyocardial biopsy specimens obtained from patients with diabetes mellitus with and without hypertension. Heart Vessels 12, 267–274 (1997). https://doi.org/10.1007/BF02766802
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02766802