Background/Objectives: Type 2 diabetes mellitus (T2DM) is a global epidemic strongly associated with an increased risk of heart failure, independent of coronary artery disease or hypertension. This condition, historically termed diabetic cardiomyopathy (DCM) and recently redefined as “diabetic myocardial disorder,” remains frequently underdiagnosed in its subclinical stages. The objective of this non-systematic review is to synthesize current evidence on the pathophysiological mechanisms, diagnostic advancements, and evolving therapeutic strategies for diabetic myocardial involvement. Methods: A comprehensive review of contemporary literature was conducted, focusing on recent consensus statements from the ESC and AHA, large-scale epidemiological data (IDF/WHO), and pivotal clinical trials (EMPA-REG, DAPA-HF, and LEADER). We analyzed the role of multimodal imaging—specifically speckle-tracking echocardiography (STE) and multiparametric cardiac magnetic resonance (CMR)—and circulating biomarkers in early phenotyping. Results: Pathophysiological drivers include lipotoxicity, oxidative stress, and AGE-mediated fibrosis. Advanced imaging techniques, such as global longitudinal strain (GLS) and CMR T1-mapping/ECV quantification, demonstrate superior sensitivity over LVEF in detecting early subendocardial dysfunction and diffuse fibrosis. Furthermore, NT-proBNP serves as a robust prognostic marker for the HFpEF-like trajectory typical of diabetes. Clinically, the therapeutic landscape has shifted with SGLT2 inhibitors and GLP-1 receptor agonists, which provide significant cardioprotection and reduction in heart failure hospitalizations through mechanisms beyond glycemic control. Conclusions: Diabetic myocardial disorder represents a complex continuum within the cardiometabolic spectrum. Early detection through multimodal imaging and biomarkers is essential for risk stratification. Integrating novel glucose-lowering therapies with proven cardiovascular benefits is now mandatory to alter the natural history of the disease and prevent progression to overt heart failure.

Patent foramen ovale (PFO) is a condition present in 20–25% of the general population and can rarely be associated with clinical conditions such as stroke, decompression sickness, desaturation, and migraine with aura. Screening for PFO for primary prevention is not recommended. Several trials have been published demonstrating the efficacy of percutaneous PFO closure in patients under 60 years of age with embolic stroke of unknown etiology. Such evidence has not been achieved in other patient groups, such as those with migraine with aura or decompression sickness. There is also a subset of patients, such as pregnant women or patients undergoing laparoscopic non-cardiac surgery, in whom an increased risk of paradoxical embolism requires preoperative stratification. In all cases, it is necessary to characterize the PFO based on the size of the shunt and the anatomy (e.g., the presence of a large tunnel, prominent Eustachian valve, atrial septal aneurysm), all factors that can increase the risk of paradoxical embolism. This review summarizes the current view on diagnostic and therapeutic work-up of PFO in light of the most recent international guidelines.