Diabetic cardiomyopathy: definition, right to exist

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.