Diabetes mellitus drives myocardial fibrosis and contractile dysfunction, contributing to cardiovascular morbidity and mortality. A registry analysis presented at the European Society of Cardiology Congress 2025 evaluated 3,868 patients undergoing cardiac magnetic resonance imaging to assess myocardial tissue characteristics and function, with a 1-year follow-up.

Among the cohort, 708 patients (18.3%) had diabetes. After adjusting for left ventricular ejection fraction, end-systolic volume, and late gadolinium enhancement mass, diabetic patients exhibited higher native T1 values (1142 ± 69 ms vs. 1132 ± 62 ms), increased myocardial mass (60 ± 20 g/m² vs. 56 ± 20 g/m²), slightly elevated T2 times, and worse global longitudinal strain (-13.5 ± 5.1% vs. -15.9 ± 5.0%).

In multivariable analysis including NT-proBNP and LGE mass, both T1 and strain remained independent predictors of the combined endpoint of all-cause mortality and heart failure hospitalization. Incorporating these parameters significantly enhanced the predictive power of baseline risk models.

These findings suggest that cardiac magnetic resonance-derived fibrosis and strain measurements could be integrated into routine cardiovascular risk stratification in diabetic patients, allowing earlier identification of high-risk individuals and targeted therapeutic interventions.