Multimodality Imaging in Diabetic Heart Disease Arnold C.T. Ng, MBBS, Victoria Delgado, MD, Roxanna Djaberi, MD, Joanne D. Schuijf, PhD, Mark J. Boogers, MD, Dominique Auger, MD, Matteo Bertini, MD, Albert de Roos, MD, PhD, Rutger W. van der Meer, MD, PhD, Hildo J. Lamb, MD, PhD, and Jeroen J. Bax, MD, PhD Abstract: Diabetic heart disease is currently defined as left ventricular dysfunction that occurs independently of coronary artery disease and hypertension. Its underlying etiology is likely to be multifactorial, acting synergistically together to cause myocardial dysfunction. Multimodality cardiac imaging, such as echocardiography, nuclear, computed tomography, and magnetic resonance imaging, can provide invaluable insight into different aspects of the disease process, from imaging at the cellular level for altered myocardial metabolism to microvascular and endothelial dysfunction, autonomic neuropathy, coronary atherosclerosis, and finally, interstitial fibrosis with scar formation. Furthermore, cardiac imaging is pivotal in diagnosing diabetic heart disease. Thus, the aim of the present review is to illustrate the role of multimodality cardiac imaging in elucidating the underlying pathophys- iologic mechanisms of diabetic heart disease. (Curr Probl Cardiol 2011;36:9-47.) Arnold C.T. Ng and Victoria Delgado contributed equally to this work and should be considered as joint first authors. Dr Boogers is financially supported by the Dutch Heart Foundation Grant 2006T102. Dr Bax received grants from Biotronik, Medtronic, Boston Scientific Corporation, Bristol-Myers Squibb Medical Imaging, St Jude Medical, GE Healthcare, and Edwards Lifesciences. Curr Probl Cardiol 2011;36:9-47. 0146-2806/$ – see front matter doi:10.1016/j.cpcardiol.2010.10.001 Curr Probl Cardiol, January 2011 9