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Background and aims: It has been previously shown that hyperglycaemia and insulin resistance can affect cardiac structure and function, independently of arterial hypertension and ischemic heart disease. Left ventricular diastolic dysfunction (LVDD) is considered to be the earliest myocardial lesion in patients with type 2 diabetes (T2D). The aim of this study was to assess the prevalence of LVDD, and to determine its predictors, clinical and metabolic correlates. Materials and Methods: In order to detect LVDD, 78 patients with T2D, without arterial hypertension, ischemic heart disease or other cardiac disease underwent high-resolution transthoracic echocardiography including tissue Doppler and exercise stressechocardiography). LVDD was diagnosed when E/E’ ratio (early mitral valve flow velocity/early diastolic lengthening velocity) was ≥15. If E/E’ ranged from 8–15, higher values of one of the additional diagnostic criteria were required: left ventricular mass index, left ventricular volume, E/A ratio, atrial fibrillation, N-terminal fragment pro B-type natriuretic peptide (NT-proBNP). Laboratory evaluation included metabolic parameters, biomarkers of inflammation and fibrinolysis, NT-proBNP, homocystein, tumor necrosis factor-⊠, and adiponectin. Minimal model test was performed to assess insulin resistance (28 patients). Results: LVDD was diagnosed in 8 patients (10.3%). These patients were older (60.6±8.4 vs. 53.1±9.1; p=0.029). HDL cholesterol (1.3±0.4 vs. 1.0±0.3mmol/l; p=0.012), and apolipoprotein A1 (2.4±0.5 vs. 1.8±0.4mmol/l; p<0.0001) were significantly elevated in patients with LVDD. Univariate analysis confirmed predictive value of age and apolipoprotein A1 for the development of LVDD, while multivariate analysis revealed apolipoprotein A1 as an independant predictor. E/E’ correlated significantly with age, HDL cholesterol, and apolipoprotein A1. Conclusion: LVDD was detected in 10.3% T2D patients without arterial hypertension, ischemic heart disease or other cardiac disease. Higher apolipoprotein A1 was recognized as independent predictor of LVDD. Early detection of LVDD in T2D may be useful to halt the progression of myocardial lesions to heart failure. [Copyright &y& Elsevier]