Aim: The aim of the study was to detect the echocardiographic sensitive indexes for prediction of the subclinical cardiac dysfunction and to evaluate the relation between Hemoglobin A1c (HbA1c) and myocardial acoustic densitometry as well as cardiac function. Methods: Fifty DM2 patients (48.5 +/- 18.6 years) without evident heart disease and 50 age- and sex-matched normal controls (47.6 +/- 8.8 years) were enrolled. Conventional echocardiography, tissue Doppler imaging and acoustic densitometry of both groups were measured. HbA1c of DM2 patients were determined. Results: There were no significant differences in systolic indexes between the two groups. Mean LV myocardial early diastolic velocity Ern and Em/Am were lower in DM group than control group. Mean LV myocardial late diastolic velocity Am and E/Em were higher in DM group than control group. IVS-IBS% and LVPW-IBS% were higher in DM group than control group. IVS-CVIB and LVPW-CVIB were lower in DM group than control group. HbA1c was negatively correlated with E/A (gamma = -0.310, P < 0.05), Ern (gamma = -0.409, P < 0.01), Em/Am (gamma = -0.380, P < 0.01) and positively correlated with E/Em (gamma = 0.488, P < 0.01). Significant positive correlation was present between HbA1c and IVS-IBS% (gamma = 0.679, P < 0.01), LVPW-IBS% (gamma = 0.666, P < 0.01). Conclusions: The diastolic dysfunction and abnormal myocardial acoustic densitometry exist before the systolic function damage in DM2 patients. Tissue Doppler imaging and ultrasonic integrated backscatter can be used as sensitive means for early assessing myocardial histological changes in DM2 patients. HbA1c is related with both diastolic dysfunction and acoustic densitometry. (C) 2009 Elsevier Ireland Ltd. All rights reserved.