The relationship of diabetes mellitus (DM) with cardiovascular mortality and morbidity has been widely established. Diabetic cardiomyopathy (DBCM) has been increasingly recognized as the development of cardiac dysfunction accompanied by heart failure (HF) symptoms in the absence of obvious causes like coronary artery disease (CAD), hypertension (HTN) or valvular diseases. The objective of this review is to critically appraise the role of echocardiography in the diagnosis and prognostic stratification of DBCM. Echocardiography remains the first-line imaging modality due to its availability, repeatability, non-invasive nature and ability to assess structural and functional changes. Classical echocardiographic indices such as left ventricular hypertrophy and systolic and diastolic dysfunction assessment provide valuable information but they lack sensitivity, often remaining normal until advanced stages of DBCM. Recently developed echocardiographic modalities, including strain imaging, myocardial work indices and left atrial strain, may allow for earlier detection of subclinical myocardial dysfunction, having important prognostic implications. However, these advanced modalities require high imaging quality, expertise and standardization, being subject to technical and physio-logical limitations. Stress echocardiography, particularly exercise-based protocols, is an increasingly recognized, valuable tool for unmasking exertional abnormalities in filling pressures, myocardial reserve and pulmonary pressures that are not evident at rest. Until now, stress echocardiography requires validation in large cohorts to assess its prognostic power. This review highlights the importance of timely recognition of DBCM, underscores the advantages and disadvantages of current echocardiographic approaches and outlines future perspectives in multimodality imaging to improve patient outcomes.

The assessment of left and right ventricular systolic function is vital information for the management of cardiac disease. Everyday clinical practice has traditionally relied on the measurement of the ejection fraction (EF). Nonetheless, EF has known limitations and may not always accurately reflect myocardial systolic performance. Intrinsic myocardial contractility may decline long before reductions in left or right ventricular EF become apparent. Adjunct parameters such as tissue Doppler-derived systolic velocities of the mitral and tricuspid annulus may detect such early abnormalities; however, they do not represent global systolic performance. Consequently, commonly used indices may exhibit suboptimal performance for the detection of systolic dysfunction. Given the limitations of current measurement methods, there is growing concern about the reliability of heart failure (HF) classification based solely on EF. The integration of advanced echocardiographic indices, such as speckle-tracking-derived strain, three-dimensional (3D) volumetric assessment, myocardial work (MW), and cardiac power output (CPO), in combination with classical parameters provides more accurate, reproducible, and clinically meaningful diagnostic and prognostic information in patients with HF. Nevertheless, despite their potential, these techniques remain underutilized in routine practice. Early identification of systolic dysfunction and timely initiation of therapy can substantially improve clinical outcomes. In this setting, this review aims to comprehensively examine both established and emerging echocardiographic techniques used for the assessment of ventricular systolic performance, with the objective of promoting their effective integration into routine clinical practice.

Background/Objectives: Cardiorenal syndrome (CRS) is associated with substantially higher morbidity and mortality than either isolated cardiac or renal dysfunction. The application of classical and novel biomarkers has been tested in prompt diagnosis and monitoring of patients with CRS. Methods: This is a comprehensive literature review following a structured approach. We searched MEDLINE and Embase databases from January 2000 to December 2025. Results: The pathophysiology of CRS is complex, and the present review attempts to shed light on the clinical interpretation of the most widely used biomarkers as indices of diagnosis and prognosis. Among them, troponin is elevated in CRS and its absolute levels retain prognostic value, while changes in its levels over time may assist in the diagnosis of acute coronary syndrome. Natriuretic peptides are highly influenced by coexistence of chronic kidney disease (CKD) and in this context have considerable diagnostic and prognostic value. The combination of cystatin C, a biomarker of renal dysfunction, with cardiac biomarkers may create a powerful risk algorithm. Most recently, gene profiling and proteomics have the potential to stratify patients with CRS; however, more data from large cohorts are required for their validation. The therapeutic modulation of biomarkers in CRS patients may help elucidate the underlying pathophysiologic mechanisms. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as first-line therapy for patients with CRS, despite the fact their mechanisms are mostly unknown. Significant changes in the aforementioned biomarkers and the inflammatory factors may explain their emerging beneficial effects on both heart failure and CKD. Conclusions: The use of biomarkers has increased rapidly in recent years for diagnosis, surveillance and prognostic stratification in CRS.