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Purpose: Diabetic patients (pts) have high risk for cardiovascular morbidity and mortality.Speckle tracking echocardiography was used to recognize myocardial dysfunction before overt clinical syndrome in diabetic cardiomyopathy and in pts with coronary artery disease(CAD). Methods:177 subjects: 50 (mean age:62 years) pts with diabetes and CAD (group A), 37 diabetic pts without CAD (negative coronary angiography) (group B), 40 CAD pts without diabetes (group C), and 50 healthy controls (group D) were studied. All pts underwent coronary angiography except controls and all had preserved left ventricular(LV) ejection fraction(EF). By System Seven GE with TVI, atrial and ventricular diameters, volumes, EF and propagation velocity(Vp) were measured. Pulmonary capillary wedge pressure(PCWP) was calculated by E/Ea. Bidimensional acquisitions were analyzed to measure longitudinal peak systolic ventricular (all segments), atrial (near the roof) S and SR in apical 4 and 2-chambers views and circumferential and radial systolic S and SR in middle short axis view.Results: All subjects except those of group D showed impaired diastolic function by PW Doppler, TVI and Vp. Pts of group A and C had high PCWP. Group A and B pts had lower atrial longitudinal systolic SR than controls (septal 1,99±0,81 vs 2,37±0,63 S-1;lateral 1,26±0,43 vs 2,52±1,32 S-1;anterior 1,61±0,76 vs 2,17±0,86 S-1;RA 1,99±0,64 vs 2,8±1,5 S-1), while atrial S was impaired only in pts of group A (15±5% vs 33±7%). All pts showed lower ventricular radial systolic S (group A:21±10%; group B:28,8±15;group C: 29,01±15) and SR (group A:1,19±0,66; group B:1,28±0,48;group C:0,89±0,31) than in controls (S=46,3±9,4%9; SR=1,58±0,51S-1). Ventricular 2D longitudinal systolic S and SR, for each segment, were impaired only in group A (basal S=-15,2±4,3; SR=-1,21±0,39S-1;mid S=-15,9±4,7;SR=-1,05±0,29S-1;apical S=-16,3±4,1%; SR=-1,01±0,21S-1) and C (basal S=-17±4;SR=-1,3±0,37S-1;mid S=-17,69±4,3;SR=-1,17±0,3S-1;apical S=-18,7±4,5%; SR=-1,2±0,29S-1). No pts had ventricular circumferential systolic S and SR impaired.Conclusions: All diabetic pts showed diastolic impairment and lower values of systolic atrial SR, expression of early pathological changes (interstitial fibrosis) of the atrial walls, and ventricular radial S and SR, an early sign of progressive diastolic dysfunction, that later may advance to DHF. Instead, pts with CAD had impaired longitudinal ventricular systolic S and SR. The ventricular circumferential S and SR were preserved in all subjects, because when systolic ejection fraction is preserved, subepicardial fibres are not involved.