Diastolic Dysfunction in Diabetes Mellitus
Summary
Diabetes mellitus is recognised as a major risk factor for heart failure, in which diastolic dysfunction frequently precedes overt systolic impairment. In this context, the term describes an abnormality of myocardial relaxation, increased chamber stiffness and impaired ventricular filling, often manifesting subclinically. These changes may arise from metabolic disturbances, including hyperglycaemia-induced advanced glycation end-product deposition, insulin resistance and lipotoxicity, which promote interstitial fibrosis and microvascular rarefaction. Concomitant alterations in calcium handling and myocardial energetics further compromise early filling and reservoir function. Clinically, diastolic dysfunction spans a continuum from subtle echocardiographic abnormalities—such as reduced early diastolic mitral annular velocity and elevated E/e′ ratio—to symptomatic heart failure with preserved ejection fraction. Its prevalence in type 2 diabetes is estimated at up to 40–50 percent, reflecting global ageing and the diabetes pandemic. Early detection through echocardiography and cardiovascular magnetic resonance is critical to halt progression and guide interventions, including glycaemic control, antihypertensive therapy and lifestyle modification. Emerging therapeutic approaches target myocardial fibrosis and microvascular protection, highlighting the potential to mitigate diastolic impairment in diabetes.
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Diastolic Dysfunction in Diabetes Mellitus publication trend
The graph below shows the total number of articles in diastolic dysfunction in diabetes mellitus across all publications each year (not limited to Nature Index journals).
Technical terms
Diastolic dysfunction: Impairment of left ventricular relaxation and filling.
Extracellular volume fraction (ECV): Proportion of myocardial tissue composed of extracellular matrix, indicating fibrosis.
Myocardial perfusion reserve (MPR): Ratio of stress to rest myocardial blood flow, reflecting microvascular function.
E/e′ ratio: Echocardiographic index of left ventricular filling pressure, derived from mitral inflow and annular velocities.
Left atrial enlargement (LAE): Increase in atrial volume as a surrogate for chronically elevated filling pressures.
References
- The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study. Cardiovascular Diabetology (2023).
- Epidemiology of heart failure in diabetes: a disease in disguise. Diabetologia (2024).
- Prevalence of diabetic cardiomyopathy in patients with type 2 diabetes in a large academic medical center. BMC Medicine (2024).
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