Early Detection of Diabetic Cardiomyopathy Using Speckle Tracking Echocardiography: A Systematic Review

Diabetic cardiomyopathy (DCM) represents a distinct myocardial disease that develops independently of coronary artery disease and hypertension in patients with diabetes mellitus. Early detection of subclinical myocardial dysfunction is crucial for timely intervention and improved patient outcomes, as traditional echocardiographic parameters often remain normal during the initial disease stages. Speckle tracking echocardiography (STE) has emerged as a sensitive, non-invasive imaging technique capable of detecting subtle myocardial deformation abnormalities before conventional parameters become abnormal. This systematic review evaluated the effectiveness of STE in early detection of DCM by analyzing original research studies that assessed myocardial strain parameters in patients with diabetes with preserved left ventricular ejection fraction. A comprehensive literature search was conducted across multiple databases from inception to June 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven studies met the inclusion criteria, encompassing 361 diabetic patients and 300 healthy controls, with publication years ranging from 2013 to 2022. The review included both type 1 and type 2 diabetes mellitus patients with varying disease durations and glycemic control levels. Global longitudinal strain emerged as the most consistently impaired parameter across all studies, demonstrating a significant reduction in patients with diabetes compared to controls despite preserved ejection fraction. Additional strain parameters, including circumferential, radial, and area strains, showed progressive impairment correlating with diabetes duration and glycemic control. Three-dimensional speckle tracking provided enhanced assessment capabilities, revealing more comprehensive myocardial dysfunction patterns. Multi-layered strain analysis demonstrated preferential endocardial involvement, supporting the pathophysiological understanding of subendocardial fiber vulnerability in the hearts of patients with diabetes. Right ventricular strain assessment revealed biventricular involvement in DCM. The findings consistently demonstrated correlations between strain abnormalities and diabetic microvascular complications, suggesting systemic disease involvement. This review provides compelling evidence supporting STE as a valuable tool for early DCM detection, enabling potential early intervention strategies to prevent progression to symptomatic heart failure.