![]() The risk of coronary artery disease in diabetesĭiabetes is associated with at least 2-fold increased risk of coronary artery disease and for many years has been regarded as ‘coronary risk equivalent’ ( 4). Thus, it is frequently not possible to decipher the contribution of ischaemic and non-ischaemic factors to the development of diabetic heart failure. Patients with diabetes, however, often present with accelerated atherosclerosis, which may lead to the development of ischaemic heart disease and subsequently heart failure reduced ejection fraction. It remains debatable if cardiac imaging could be also used to screen asymptomatic patients with diabetes for the presence for early signs of heart disease. ![]() Multi-modality imaging is particularly useful in monitoring disease progression and evaluating the effectiveness of medical interventions. The aetiology of so-called diabetic cardiomyopathy remains unknown but is likely multifactorial and therefore more difficult to characterise by a single modality. In type 1 diabetes as compared to type 2 diabetes, the cardiovascular mortality remains similar, however, the impact of hyperglycaemia on the risk of development of heart disease is more pronounced in type 1 diabetes ( 3). ![]() Numerous studies have explored pathophysiological mechanisms underlying changes in the cardiac structure and resulting function leading to the development of heart failure because of diabetes. This has given rise to the worldwide epidemic of diabetic cardiomyopathy, a condition covering the spectrum of myocardial abnormalities linked to the underlying metabolic disturbances observed in patients with diabetes in the absence of coronary artery disease. Global prevalence of diabetes mellitus has been increasing rapidly over the last decade. In this review, we describe the roles of multimodality cardiac imaging in detecting the impact of diabetes on the myocardium and its use for longitudinal follow up. Early detection of the effect of diabetes on the cardiovascular system could improve preventive measures and initiation of treatments with proven cardiovascular benefit. On average, a 50-year-old with diabetes but no history of vascular disease dies approximately 6 years younger than a counterpart without diabetes ( 2). Diabetes is associated with a significant shortening of life. Patients with diabetes are 2–3 times more likely to have heart disease and 84% of people over 65 with diabetes die from heart disease and stroke. World Health Organisation estimates that there are 422 million people living with diabetes mellitus worldwide and 1.5 million deaths are attributed to diabetes annually ( 1). Finally, we discuss recent data regarding the use of artificial intelligence applied to large imaging databases and how those efforts can be utilised in the future in screening of patients with diabetes for early signs of disease. Furthermore, we discuss the role of MRI-derived techniques in studying altered myocardial metabolism linking diabetes with the development of diabetic cardiomyopathy. We also describe emerging imaging techniques enabling early detection of coronary artery inflammation and the non-invasive characterisation of the atherosclerotic plaque disease. In this review we summarise the utility of multi-modality cardiac imaging in characterising ischaemic and non-ischaemic causes of diabetic heart disease and give an overview of the current clinical practice. Multimodality cardiac imaging, including echocardiography, cardiac computed tomography, nuclear medicine, and cardiac magnetic resonance play crucial role in the diagnosis and management of different pathologies included in the definition of diabetic heart disease. Premature coronary artery disease and heart failure are leading causes of morbidity and reduced life expectancy. Patients with diabetes show an excess of death from cardiovascular causes, twice as high as the general population and those with diabetes type 1 and longer duration of the disease present with more severe cardiovascular complications.
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