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Updated: Oct 14, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the
Thomas H Marwick1, Alessia Gimelli2, Sven Plein3
1Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
Insights
Diabetes mellitus (DM) significantly increases heart failure (HF) risk. Detecting early left ventricular dysfunction (LVD) in DM patients is crucial for targeted cardioprotection and improved outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Heart failure (HF) is a frequent complication of diabetes mellitus (DM).
- Subclinical left ventricular dysfunction (LVD) in DM patients indicates HF risk.
- DM-related LVD is heterogeneous, encompassing systolic, diastolic, or mixed dysfunction.
Purpose of the Study:
- To review strategies for screening LVD in DM.
- To explore methods for identifying LVD pathogenesis in DM.
- To discuss potential treatment pathways for DM-associated LVD.
Main Methods:
- Review of current literature on HF in DM.
- Discussion of imaging techniques for LVD detection and phenotyping.
- Analysis of mechanisms contributing to LVD in DM.
Main Results:
- Individuals with DM are at increased risk of HF.
- Evidence suggests cardioprotective benefits are possible.
- Current evidence lacks sufficient justification for routine HF screening based on LVD detection alone.
Conclusions:
- Effective management requires phenotyping LVD mechanisms (fibrosis, metabolism, etc.).
- Imaging strategies should detect LVD and characterize its pathogenesis.
- Further evidence is needed to link LVD detection, treatment, and improved patient outcomes.
Abstract:
Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.
