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Impact of type 2 diabetes and the metabolic syndrome on myocardial structure and microvasculature of men with coronary artery disease

Duncan J Campbell12*, Jithendra B Somaratne4, Alicia J Jenkins2, David L Prior124, Michael Yii35, James F Kenny5, Andrew E Newcomb35, Casper G Schalkwijk6, Mary J Black7 and Darren J Kelly2

Author Affiliations

1 Department of Molecular Cardiology, St. Vincent's Institute of Medical Research, Fitzroy, Australia

2 Department of Medicine, University of Melbourne, St. Vincent's Health, Fitzroy, Australia

3 Department of Surgery, University of Melbourne, St. Vincent's Health, Fitzroy, Australia

4 Department of Cardiology, St. Vincent's Health, Fitzroy, Australia

5 Department of Cardiothoracic Surgery, St. Vincent's Health, Fitzroy, Australia

6 Department of Internal Medicine, University of Maastricht, Maastricht, The Netherlands

7 Department of Anatomy and Developmental Biology, Monash University, Clayton, Australia

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Cardiovascular Diabetology 2011, 10:80  doi:10.1186/1475-2840-10-80

Published: 19 September 2011



Type 2 diabetes and the metabolic syndrome are associated with impaired diastolic function and increased heart failure risk. Animal models and autopsy studies of diabetic patients implicate myocardial fibrosis, cardiomyocyte hypertrophy, altered myocardial microvascular structure and advanced glycation end-products (AGEs) in the pathogenesis of diabetic cardiomyopathy. We investigated whether type 2 diabetes and the metabolic syndrome are associated with altered myocardial structure, microvasculature, and expression of AGEs and receptor for AGEs (RAGE) in men with coronary artery disease.


We performed histological analysis of left ventricular biopsies from 13 control, 10 diabetic and 23 metabolic syndrome men undergoing coronary artery bypass graft surgery who did not have heart failure or atrial fibrillation, had not received loop diuretic therapy, and did not have evidence of previous myocardial infarction.


All three patient groups had similar extent of coronary artery disease and clinical characteristics, apart from differences in metabolic parameters. Diabetic and metabolic syndrome patients had higher pulmonary capillary wedge pressure than controls, and diabetic patients had reduced mitral diastolic peak velocity of the septal mitral annulus (E'), consistent with impaired diastolic function. Neither diabetic nor metabolic syndrome patients had increased myocardial interstitial fibrosis (picrosirius red), or increased immunostaining for collagen I and III, the AGE Nε-(carboxymethyl)lysine, or RAGE. Cardiomyocyte width, capillary length density, diffusion radius, and arteriolar dimensions did not differ between the three patient groups, whereas diabetic and metabolic syndrome patients had reduced perivascular fibrosis.


Impaired diastolic function of type 2 diabetic and metabolic syndrome patients was not dependent on increased myocardial fibrosis, cardiomyocyte hypertrophy, alteration of the myocardial microvascular structure, or increased myocardial expression of Nε-(carboxymethyl)lysine or RAGE. These findings suggest that the increased myocardial fibrosis and AGE expression, cardiomyocyte hypertrophy, and altered microvasculature structure described in diabetic heart disease were a consequence, rather than an initiating cause, of cardiac dysfunction.

Diabetic cardiomyopathy; type 2 diabetes; metabolic syndrome; fibrosis; capillary length density; advanced glycation end-products