Associations between cardiometabolic traits and diabetic cardiomyopathy: an imaging-based analysis

Diabetic cardiomyopathy (DCM) often evades diagnosis before manifestation of clinical symptoms. In this study we explored how cardiometabolic traits influence early cardiac structure and function in asymptomatic people living with diabetes (PwD), using advanced imaging. We conducted a cross-sectional study of 88 participants: 57 people living with type 2 diabetes (PwT2D), 16 people living with type 1 diabetes (PwT1D) and 15 controls. All subjects underwent transthoracic echocardiography and/or cardiac magnetic resonance (CMR) imaging. Strain analysis, perfusion indices, and tissue characterization (T1, T2, and extracellular volume) were assessed. Arterial stiffness via pulse wave velocity (PWV), ventricular-arterial coupling (VAC), circulating biomarkers and liver fibrosis indices were evaluated. PwD had lower cardiac index than controls. Global longitudinal strain (GLS) and global radial strain were lower in both diabetes mellitus (DM) groups, while left atrial strain was most impaired in PwT2D (β-coefficient= − 11.77, P= 0.003). DM duration ≥ 10 years was associated with worse GLS (β-coefficient= − 2.18, P= 0.033) and right VAC (β-coefficient= − 0.27, P= 0.027) after multivariable analysis. While tissue characterization and perfusion indices showed no significant group differences, tight glycemic control in PwD correlated with improved myocardial strain parameters. PwT2D exhibited greater arterial stiffness (β-coefficient= 1.52, P= 0.003). In PwD, elevated non-alcoholic fatty liver disease score correlated with increased left ventricular mass (β-coefficient= 6,195, P= 0.022) and decreased left ventricular ejection fraction (LVEF) (β-coefficient= − 3.12, P= 0.017). Higher growth differentiation factor levels were associated with reduced LVEF (β-coefficient= − 0.005, P= 0.029). This multimodal imaging study highlights myocardial and vascular changes in asymptomatic PwD. Early comprehensive cardiovascular assessment may help identify dysfunction before overt heart failure develops.