Background: Diabetic patients may develop subclinical myocardial dysfunction despite preserved ejection fraction (EF≥50%) and normal Doppler indices. Speckle-tracking echocardiography (STE) detects these abnormalities earlier, but STE is resource-intensive and not universally available. A machine-learning model using routine clinical data could identify high-risk patients for targeted imaging and earlier intervention. Objective: To develop and validate a leakage-safe machine-learning approach identifying subclinical myocardial dysfunction—defined as abnormal STE despite EF≥50% and normal Doppler parameters—in adults with diabetes. Methods: We analyzed a single-center cohort of diabetic adults. Positive class: EF≥50%, normal Doppler indices (E/e′≤14, tricuspid regurgitation velocity≤2. 8 m/s, left atrial volume index≤34 mL/m²), and abnormal global longitudinal strain (GLS). Negative class: same EF/Doppler criteria with normal GLS; others were excluded. Input features included demographics, vitals, anthropometrics, comorbidities, medications, and laboratories. All STE variables were excluded to prevent circularity. Preprocessing (median imputation, one-hot encoding, scaling) used a unified pipeline. Grouped 5-fold cross-validation by patient ID prevented patient-level leakage. Primary metrics: AUROC and average precision (AP). Models tested: logistic regression, random forest, and XGBoost. Results: Among 233 eligible patients, 199 (85. 4%) were GLS-abnormal and 34 (14. 6%) GLS-normal. XGBoost achieved perfect discrimination (AUROC 1. 000, AP 1. 000) in cross-validation and out-of-fold testing. Random Forest performed strongly (CV AUROC 0. 963±0. 022, AP 0. 994±0. 003; OOF AUROC 0. 962, AP 0. 994), surpassing logistic regression (CV AUROC 0. 788±0. 059, AP 0. 961±0. 008; OOF AUROC 0. 800, AP 0. 961). Routine clinical variables accurately identified STE-positive patients. Given exceptional XGBoost performance, sensitivity analyses and external validation are warranted. Conclusions: Leakage-aware ML using standard clinical data can flag diabetic patients with STE-defined subclinical dysfunction despite preserved EF and normal Doppler indices, enabling earlier risk stratification and targeted imaging before symptomatic heart failure. Future work includes multi-center validation, calibration assessment, and clinical workflow integration.
Tran et al. (Tue,) studied this question.