Two-dimensional speckle tracking echocardiography was more sensitive than traditional echocardiographic techniques for detecting early left ventricular diastolic dysfunction among patients with type 2 diabetes (T2D), according to study findings presented in a poster at the American Society of Echocardiography (ASE) 2025 Scientific Sessions.

“These findings support incorporating strain imaging into routine assessment of [patients with diabetes],” the study authors, led by Tam QM Tran, MS, a student at Washington University School of Medicine in St. Louis, wrote in their poster.

Among patients with T2D, diabetic cardiomyopathy is often preceded by diastolic dysfunction prior to systolic dysfunction before clinical symptoms are observable.

Diastolic abnormalities indicating dysfunction can be missed on traditional echocardiography, however, especially among patients with preserved ejection fraction. Whereas speckle tracking echocardiography provides a better picture of myocardial deformation.

With earlier detection of diastolic abnormalities, patients with T2DM could receive preventive care to avoid progression to overt heart failure.

Study authors conducted a cross-sectional evaluation of the diagnostic performance of 2D speckle tracking echocardiography compared with traditional echocardiographic methods in the detection of early left ventricular diastolic dysfunction in patients with T2D.

Echocardiography was completed with the Philips Affiniti 70 ultrasound system. Parameters for assessment of traditional echocardiography included E/e’ ratio, septal/lateral e’ velocities, left atrial volume index, and tricuspid regurgitation velocity.

Speckle tracking echocardiography was conducted with QLAB software, version 15.0. Assessment for speckle tracking cardiograph include individual strain parameters of early and late diastolic longitudinal and circumferential strain rate as well as strain rate ratios.

The study included 188 patients with T2D and 119 age-matched controls. All patients had preserved left ventricular ejection fraction of at least 50%. Among all participants, patients with T2D were slightly older (67 vs 64 years) but the gender distribution was the same in both arms with 37% being male. Patients with T2D were more likely to have a higher body mass index, higher hemoglobin A1c. and greater wall thickness.

Early diastolic longitudinal strain rate showed the highest diagnostic value for speckle tracking echocardiography with an area under the curve (AUC) of 0.661 (P < .05); the sensitivity was 63% and the specificity was 68%.

Next highest was the strain rate ratio for early to late diastolic circumferential strain, with an AUC of 0.620 (P < .05). The sensitivity rate was 46.8% and the specificity rate was 80.7%. With the late diastolic longitudinal strain rate, the AUC was 0.592 (P < .05), with a sensitivity of 45.2% and a specificity of 73.9%. For late diastolic circumferential strain rate, the AUC was 0.612 (P < .01), with a sensitivity of 47.3% and a specificity of 73.1%.

Upon traditional echocardiography, most of the patients with T2D, 84.6% had normal diastolic function by ASE/European Association of Cardiovascular Imaging criteria, 13.8% had intermediate function, and 1.6% had definite dysfunction. Subtle differences were observed with increased E/e’ and reduced lateral e’.

When traditional and strain models were combined, it improved diagnostic performance for an even greater AUC of 74%, whereas individual parameters of strain only led to an AUC of 69% and 63% for traditional parameters only.

Among 159 patients with T2D who were considered to have normal diastolic function through traditional imaging, 64% had an abnormal early diastolic longitudinal strain rate, 61% had an abnormal early to late diastolic longitudinal strain rate ratio, and 54% had an abnormal late diastolic longitudinal strain rate.

Due to these findings, Tran et al noted that “early diastolic longitudinal strain rate may serve as a valuable biomarker for subclinical diastolic dysfunction.”