diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13250diaendo-13250Research ArticleОБЗОРЫREVIEWSДиабетическая кардиомиопатия: дефиниция, право на существованиеDiabetic cardiomyopathy: definition, right to existhttps://orcid.org/0000-0001-7911-2424МарковаТ. Н.MarkovaT. N.

Маркова Татьяна Николаевна - д.м.н., профессор.

Москва

Tatyana N. Markova - MD, PhD, Professor.

Moscow

markovatn18@yandex.ruhttps://orcid.org/0000-0002-6895-5538ОвчинниковаМ. А.OvchinnikovaM. A.

Овчинникова Маргарита Александровна – аспирант.

127473, Москва, ул. Делегатская, д. 20, стр. 1

Margarita A. Ovchinnikova - postgraduate student.

20/1 Delegatskaya street, 127473 Moscow

joi.rirn@mail.ruhttps://orcid.org/0009-0002-2677-6512ШкодкинаВ. В.ShkodkinaV. V.

Шкодкина Виктория Витальевна - клинический ординатор.

Москва

Victoria V. Shkodkina - clinical resident.

Moscow

https://orcid.org/0009-0006-7368-2964БеляеваО. А.BelyaevaO. A.

Беляева Ольга Александровна - клинический ординатор.

Москва

Olga A. Belyaeva - clinical resident.

Moscow

olya.bely0906@yandex.ruРоссийский университет медицины; Городская клиническая больница № 52РоссияROSUNIMED; Moscow City Clinical Hospital № 52Russian FederationРоссийский университет медициныРоссияROSUNIMEDRussian Federation202509102025284384393Copyright © Маркова Т.Н., Овчинникова М.А., Шкодкина В.В., Беляева О.А., 20252025Маркова Т.Н., Овчинникова М.А., Шкодкина В.В., Беляева О.А.Markova T.N., Ovchinnikova M.A., Shkodkina V.V., Belyaeva O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13250

Известно, что при сахарном диабете (СД) патология сердца может развиться не только вследствие поражения коронарных артерий. Не менее значимую роль играет некоронарогенная дисфункция миокарда, в том числе связанная с хронической гипергликемией. В 2024 г. опубликован консенсусный документ, разработанный экспертами Ассоциации специалистов по хронической сердечной недостаточности (ХСН) при Европейском обществе кардиологов (ESC) и рабочей группой по заболеваниям миокарда и перикарда ESC, в котором впервые предложен термин «Диа­бетическое заболевание миокарда», или «Диабетическая дисфункция миокарда». Данное состояние определяется как систолическая и/или диастолическая дисфункция миокарда при СД и развивается под сочетанным влиянием нескольких факторов, при этом главенствующая роль отводится гипергликемии. Понятие «диабетическая кардиомиопатия» (ДКМ) в течение долгого времени активно используется учеными, однако к настоящему моменту не внедрено на уровне осложнений СД по аналогии с диабетической нефропатией и не входит в спектр заболеваний, причисленных к диабетической макроангиопатии. Патологические процессы, характерные для ДКМ и ХСН с сохраненной фракцией выброса (ХСНсФВ) при СД, сходны, в связи с чем данные состояния нередко приравниваются. Диагностическая концепция ХСНсФВ совершенствуется. Пациентам с СД 2 типа (СД2) и бессимптомными структурными и/или функциональными аномалиями миокарда, согласно современным представлениям, диагностируется субклиническая ХСН. Важность своевременного распознавания этой стадии заключается в том, что текущие возможности терапии при СД2 позволяют остановить или замедлить ее прогрессирование до симптоматической ХСН. В настоящей статье обсуждаются актуальные взгляды на этиопатогенез ДКМ у пациентов с СД, резюмируются рекомендации по диагностическим возможностям диастолической дисфункции миокарда, субклинической ХСН и ХСНсФВ, подчеркивается значимость своевременной оценки риска развития клинически манифестной ХСН у пациентов с СД2.

It is known that in diabetes mellitus (DM), cardiac pathology can develop not only as a result of damage to the coronary arteries. No less significant is the role of non-coronary myocardial dysfunction, including that associated with chronic hyperglycemia. In 2024, a consensus document was published, developed by experts from the Heart Failure (HF) Association of the European Society of Cardiology (ESC) and the Working Group on Myocardial and Pericardial Diseases of the ESC, in which the term «diabetic myocardial disorder» was proposed for the first time. This condition is defined as systolic and/or diastolic myocardial dysfunction in DM and develops under the combined influence of several factors, with hyperglycemia playing the leading role. The concept of «diabetic cardiomyopathy» (DCM) has been actively used by scientists for a long time, but to date it has not been implemented at the level of complications of DM by analogy with diabetic nephropathy and is not included in the spectrum of diseases classified as diabetic macroangiopathy. Pathological processes characteristic of DCM and HF with preserved ejection fraction (HFpEF) in DM are similar, and therefore these conditions are often equated. The diagnostic concept of HFpEF is being improved. According to modern concepts, patients with type 2 DM (DM2) and asymptomatic structural and/or functional myocardial abnormalities are diagnosed with subclinical HF. The importance of timely recognition of this stage is that current treatment options for DM2 make it possible to stop or slow down its progression to symptomatic HF. This article discusses current views on the etiopathogenesis of DCM in patients with DM, summarizes recommendations on the diagnostic capabilities of diastolic myocardial dysfunction, subclinical HF and HFpEF, and emphasizes the importance of timely assessment of the risk of developing clinically manifest HF in patients with DM2.

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The authors declare that there are no conflicts of interest present.