Diabetes mellitus is an established risk factor for cardiovascular events. Aims of the study were to assess left ventricular systolic and diastolic function in asymptomatic patients with type 2 diabetes and evaluate the relations among left ventricular function and specific diabetic complications. Seventy-three normotensive patients with type 2 diabetes and no clinical evidence of cardiac disease were studied. Thirty-four healthy subjects served as control group. Echocardiographic studies were performed to assess left ventricular systolic and diastolic function. Microangiopathy was assessed by fundoscopy. Autonomic function was evaluated by standing blood pressure and heart rate response to Valsalva maneuver. Patients with type 2 diabetes had a lower ejection fraction (54 +/- 10.8 vs. 67 +/- 6.1%, p < or = 0.001), E-velocity (50.1 +/- 10.6 vs. 58.4 +/- 6.3 cm/s, p < or = 0.001), and E/A ratio of <1 (54.8 vs. 5.8%, p < or = 0.01) of the mitral diastolic flow compared with the control subjects, respectively. Patients with ejection fraction <50% had higher prevalence of retinopathy (52.9 vs. 26.7%, p < or = 0.05), abnormal blood pressure response to standing (52.9 vs. 7.1%, p < or = 0.001), and proteinuria (70.5 vs. 14.2%, p < or = 0.05). An inverse correlation was found between duration of diabetes and both ejection fraction (r = -0.53, p = 0.05) and E/A ratio (r = 0.36, p = 0.003). E/A ratio of <1 was associated with higher prevalence of retinopathy (45 vs. 18.1%, p < or = 0.05) and abnormal blood pressure response to standing (25 vs. 9%, p < or = 0.05). Multiple logistic regression model showed that diabetes was the strongest independent correlate of diastolic dysfunction (odds ratio 8.91, 95% CI: 4.18-18.52, p < or = 0.001). Asymptomatic diabetic patients have reduced left ventricular systolic and diastolic function as compared with healthy subjects. Left ventricular systolic and diastolic abnormalities are correlated with the duration of diabetes and with diabetic microangiopathies, like retinopathy and neuropathy. Diabetes mellitus is the strongest independent correlate of left ventricular diastolic dysfunction.