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Cardiovascular Diabetology (2026) 25:4  \n[https://doi.org/10.1186/s12933-025-03019-6](https://doi.org/10.1186/s12933-025-03019-6)  \nCardiovascular Diabetology  \nREVIEW Open Access  \nCardiac MRI in diabetic cardiomyopathy: translating imaging biomarkers into clinical practice  \nShan Huang 1,2†, Xueming Li 1,2†, Lu Zhang 1,2, Ran Sun 1,2, Hanrui Liu 1,2, Xinyuan Zhang 1,2, Ke Shi3, Li Jiang3, Hildo J. Lamb4, Zhigang Yang3* andYingkun Guo 1,2*  \nAbstract  \nDiabetic cardiomyopathy (DbCM) is a progressive cardiac disorder characterized by left ventricular dysfunction in the presence of diabetes mellitus. With the rising global prevalence of diabetes, early detection and intervention are crucial to prevent transition to overt heart failure. Cardiac magnetic resonance (CMR) has emerged as a powerful non-invasive imaging modality, providing comprehensive insights into myocardial structure, function, and tissue characteristics. This review highlights the role of multiparametric CMR, including T1 mapping, late gadolinium enhancement, strain analysis, perfusion imaging, and spectroscopy, in identifying key pathological features of DbCM such as diffuse fibrosis, microvascular dysfunction, steatosis, and subclinical systolic/diastolic impairment. Furthermore, we discuss how these imaging biomarkers can stratify risk, monitor disease progression, and evaluate treatment efficacy, particularly in the context of comorbidities and emerging therapies such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Future directions include the integration of artificial intelligence for automated analysis and the development of molecular imaging probes for targeted detection of early disease pathways. CMR holds significant promise for translating advanced imaging biomarkers into clinical practice, enabling personalized management of DbCM.  \nKeywords Diabetes mellitus, Diabetic cardiomyopathy, Cardiac magnetic resonance imaging, Myocardial dysfunction, Myocardial tissue characteristics  \n†Shan Huang and Xueming Li are co-first authors.  \n*Correspondence: Zhigang Yang [yangzg666@163.com](yangzg666@163.com)[ ](yangzg666@163.com)Yingkun Guo [gykpanda@163.com](gykpanda@163.com)  \nFull list of author information is available at the end of the article  \nIntroduction  \nDiabetic cardiomyopathy (DbCM) is a well-recognized clinical entity characterized by left ventricular (LV) dysfunction in the presence of diabetes mellitus (DM). Its prevalence is rising in parallel with the global increase in DM [1, 2]. Importantly, asymptomatic cardiac structural and functional abnormalities are frequently observed in Type 2 DM (T2DM) patients and are associated with an increased risk of heart failure (HF) [3]. Consequently, this subclinical stage is increasingly conceptualized as “preHF” within the broader HF trajectory [4]. Timely identification of this stage is of great importance, as it represents  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](v","cbCaisj1vuSFQVEX","https://ap.wps.com/l/cbCaisj1vuSFQVEX","pdf",1843229,"English","# Abstract\n# Introduction\n## New definition of DbCM\n## Staging and phenotyping","[{\"question\":\"What clinical problem does this review focus on?\",\"answer\":\"It focuses on diabetic cardiomyopathy (DbCM), a progressive condition involving left ventricular dysfunction in patients with diabetes mellitus, and the need for early detection to prevent progression to overt heart failure.\"},{\"question\":\"How does cardiac magnetic resonance help in diagnosing DbCM?\",\"answer\":\"CMR provides comprehensive assessment of myocardial structure, function, and tissue characteristics, using multiparametric techniques such as T1 mapping, late gadolinium enhancement, strain analysis, perfusion imaging, and spectroscopy.\"},{\"question\":\"Which imaging biomarkers are discussed for risk and treatment evaluation?\",\"answer\":\"The review discusses biomarkers linked to diffuse fibrosis, microvascular dysfunction, steatosis, and subclinical systolic/diastolic impairment, and explains how they can stratify risk, monitor progression, and evaluate treatment efficacy.\"}]","Cardiac MRI in diabetic cardiomyopathy - translating imaging biomarkers into clinical practice | PDF",1790749470,35]