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World J Cardiol. Aug 26, 2020; 12(8): 409-418
Published online Aug 26, 2020. doi: 10.4330/wjc.v12.i8.409
Forensic interrogation of diabetic endothelitis in cardiovascular diseases and clinical translation in heart failure
Merlin C Thomas, Pupalan Iyngkaran
Merlin C Thomas, Department of Diabetes, Monash University, Melbourne 3004, Victoria, Australia
Pupalan Iyngkaran, Werribee Mercy Sub School, School of Medicine Sydney, University of Notre Dame, Northcote 3070, Victoria, Australia
Author contributions: Thomas MC and Iyngkaran P drafted and critically revised the manuscript in all stages.
Conflict-of-interest statement: All co-authors have won independent and governmental research funding. None pose a conflict of interest for this review.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Merlin C Thomas, FRACP, MBBS, PhD, Professor, Department of Diabetes, Monash University, Level 5, 99 Commercial Rd, St Kilda Rd Central, Melbourne 3004, Victoria, Australia. merlin.thomas@monash.edu
Received: March 25, 2020
Peer-review started: March 25, 2020
First decision: June 5, 2020
Revised: June 5, 2020
Accepted: July 18, 2020
Article in press: July 18, 2020
Published online: August 26, 2020
Processing time: 139 Days and 1.4 Hours
Abstract

Diabetic heart disease (DHD) can be classified as a primary consequence from several pathophysiological manifestation of diabetes mellitus (DM) on cardiac tissues or secondarily in extracardiac tissues and is encountered as either primary or secondary complications of DM. Endothelitis is inflammation of the vascular endothelium and is likely to be seen in the majority of patients who start to manifest an end organ complication of DM in this case DHD. Diabetes is a leading cause for many cardiovascular syndromes and diseases including congestive heart failure (CHF) however much remains unknown about the transition from diagnosed DM to clinical state and the contribution of the various mechanical and counterregulatory systems in the manifested complaint. Diastolic heart failure or heart failure with preserved ejection fraction (DHF/HFpEF), accounts for half of all CHF presentations, has DM as a major contributor, however, there remain large gaps in clinical and pathophysiological understanding. This review aims to explore the microscopic aspects in diabetic endothelitis and provide a clinical link to with context to HFpEF.

Keywords: Cardiovascular disease; Diabetic heart disease; Diabetes mellitus; Diastolic heart failure; Endothelitis; Heart failure with preserved ejection fraction; Inflammation

Core tip: We discuss the concept of diabetes mellitus and inflammation in the endothelium of blood vessels or “diabetic endothelitis”. The vascular endothelium permeates every organ in the body. Macro and microvascular inflammation in coronary and related arterial beds contributes to diabetic heart diseases such as congestive heart failure. Heart failure with preserved ejection fraction is an important and poorly understood condition. In this review we provide a basic science perspective and a clinical link to this problem.