Strain, perfusion, and fat in the diabetic heart

Clinical and experimental studies indicate an association between diabetes mellitus and myocardial dysfunction, eventually leading to congestive heart failure irrespective of the presence or absence of arterial hypertension and coronary artery disease. However, myocardial dysfunction due to diabetes mellitus, referred to as “diabetic cardiomyopathy,” is not generally accepted as a distinct clinical entity. Because patients with myocardial dysfunction due to diabetes are at substantially higher risk for life-threatening arrhythmias and death, their early identification is crucial. This review aims to present distinct aspects of diabetic cardiomyopathy and their identification by cardiac magnetic resonance (CMR) techniques. Such noninvasive imaging techniques can aid in the early detection of myocardial dysfunction in diabetes and possibly shed light on the underlying pathophysiologic mechanisms. In this regard, echocardiography is the most widely available and frequently used imaging technique for the assessment of myocardial function in patients with diabetes. However, the diagnostic performance of echocardiography depends on the experience of the operator and the echogenic window of the patients. By contrast, the versatility of CMR allows the assessment of myocardial function, deformation, perfusion, viability, and, if required, metabolism within a single examination and without radiation exposure for the patients. For this reason, CMR represents an attractive alternative for the detection of subtle alterations of myocardial function in diabetic cardiomyopathy, particularly in overweight patients with poor echogenic windows. L Heart Metab. 2015;68:15-19