BACKGROUND: In normal subjects, left ventricular (LV) dimensions have been shown to decrease over time, while wall thickness is increasing. The aim of this study was to investigate LV remodeling in a cohort of patients with type 2 diabetes mellitus during a 3-year follow-up period and its potential association with decreased longitudinal systolic strain (epsilonL). METHODS: One hundred seventy-two patients with type 2 diabetes without overt heart disease were prospectively enrolled and underwent echocardiography with speckle-tracking imaging to assess global LV epsilonL at baseline and at 3 years. The associations between alteration in epsilonL (defined as \textbarepsilonL\textbar \textless 18%), LV geometry at baseline, and LV remodeling over time were evaluated. RESULTS: Among the 172 enrolled patients, 154 completed 3-year follow-up. At baseline, patients with epsilonL alteration had higher LV end-systolic volumes (28 +/- 11 vs 23 +/- 9 mL, P \textless .001) and relative wall thicknesses (RWT; 0.44 +/- 0.06 vs 0.40 +/- 0.07, P = .008) compared with those with normal epsilonL. At 3-year follow-up, RWTs remained stable in both groups. LV volumes significantly decreased in patients with normal epsilonL but not in patients with epsilonL alteration. Multivariate analysis showed that epsilonL alteration was independently associated with LV end-systolic volume (beta = 5.0, P = .006) and RWT (beta = 0.03, P = .03) at baseline and with changes in both LV end-diastolic volume (beta = 19.1, P = .001) and LV end-systolic volume (beta = 2.6, P = .047) over 3 years. CONCLUSIONS: In patients with type 2 diabetes, epsilonL alteration was associated with higher RWT and LV volumes and with the absence of decreases in LV volumes over time, which might be an early sign of adverse LV remodeling.