Speckle tracking echocardiography in patients with diabetes mellitus: a systematic review

Relevance Speckle tracking echocardiography (STE) constitutes a notable progression in the realm of non-invasive cardiac imaging, facilitating accurate quantification of myocardial deformation across various planes. This modality surpasses traditional echocardiographic metrics, such as left ventricular ejection fraction (LVEF), by allowing for the early identification of subclinical myocardial dysfunction. This review delineates the foundational principles and technological advancements associated with STE, encompassing the incorporation of deep learning algorithms, high-frame-rate imaging, and three-dimensional applications that enhance tracking precision and clinical applicability. Particular attention is directed toward the significance of global longitudinal strain (GLS) as a sensitive biomarker indicative of early systolic impairment. The clinical significance of STE is particularly pronounced in individuals with type 1 diabetes mellitus (T1DM), a cohort that is at an increased risk for the onset of cardiovascular complications. Numerous studies illustrate that STE can detect myocardial strain abnormalities in diabetic patients well in advance of the appearance of overt cardiac symptoms or declines in LVEF. This capability facilitates the earlier recognition of diabetic cardiomyopathy, enhances the monitoring of therapeutic responses, and permits risk stratification based on parameters such as GLS and atrial strain. Conclusion: STE has emerged as an invaluable instrument in contemporary cardiology, particularly for the diabetic demographic, where it unveils subtle myocardial dysfunction frequently overlooked by conventional methods. Its expanding role in cardio-oncology, heart failure management, and diabetes care underscores the necessity for broader clinical integration. Nevertheless, additional prospective, outcome-based studies are imperative to validate its prognostic significance and to effectively incorporate it into standard clinical practice. By bridging the divide between imaging and early intervention, STE presents promising trajectories for the enhancement of long-term cardiovascular outcomes. © 2025 Elsevier B.V., All rights reserved.