# Subclinical Myocardial Dysfunction in Type 2 Diabetes Mellitus: Insights from Left Ventricular Diastolic Function and Global Longitudinal Strain Assessment

## TL;DR

This study finds that many type 2 diabetes patients with normal heart pumping show hidden heart issues, which could help in early detection and better care.

## Contribution

The study identifies subclinical myocardial dysfunction in T2DM patients using GLS and diastolic function assessments.

## Key findings

- LV diastolic dysfunction was found in 53.9% of T2DM patients with preserved EF.
- Reduced GLS was observed in 13.4% of patients, independently linked to male sex and diastolic dysfunction.

## Abstract

Background/Objectives: Diabetic cardiomyopathy in type 2 diabetes mellitus (T2DM) often progresses silently, manifesting as diastolic dysfunction or subtle systolic impairment despite preserved ejection fraction (EF). Detecting these changes early is critical to prevent symptomatic heart failure. This study assessed the prevalence of left ventricular (LV) diastolic dysfunction and impaired global longitudinal strain (GLS) in T2DM patients with preserved EF and identified related risk factors. Methods: We performed a cross-sectional study of 232 adults with T2DM and EF > 50% at a tertiary hospital. Standard transthoracic and speckle-tracking echocardiography were used to evaluate LV diastolic function and GLS. Logistic regression identified predictors of myocardial dysfunction. Results: LV diastolic dysfunction was found in 53.9% of patients, while 13.4% showed impaired GLS (>–17.9%). Independent predictors of diastolic dysfunction were age ≥ 60 years (OR = 2.51, 95% CI: 1.25–5.07, p = 0.010) and diabetes duration of 5–10 years (OR = 3.06, 95% CI: 1.46–6.40, p = 0.003). Reduced GLS was independently associated with male sex (OR = 2.45, p = 0.040) and the presence of diastolic dysfunction (OR = 3.14, p = 0.010). Conclusions: Subclinical myocardial dysfunction is common in Vietnamese T2DM patients with preserved EF. Both diastolic dysfunction and reduced GLS may occur independently or together, influenced by age, sex, and diabetes duration. Incorporating GLS into echocardiographic evaluation may enhance early detection and support tailored cardiovascular risk management in this high-risk group.