Background <p>Type 2 diabetes mellitus (T2DM) combined with microalbuminuria (MAU) is an increasingly serious health issue, particularly among the elderly, often accompanied by severe complications such as heart failure (HF). This study aims to evaluate early changes in left ventricular (LV) myocardial work in T2DM patients with MAU using the LV pressure-strain loop (PSL) technique.</p> Methods <p>The study included 50 elderly patients with T2DM, 50 elderly patients with T2DM combined with MAU, and 50 healthy elderly controls. Based on conventional echocardiography and two-dimensional speckle tracking echocardiography, the PSL technique was used to measure LV myocardial work parameters.</p> Results <p>We observed significant differences in cardiac function parameters between elderly T2DM patients with and without MAU. Compared with the normal control group, elderly T2DM patients showed significant reductions in GLS, GWI, GCW, and GWE, while GWW was significantly increased. Additionally, T2DM patients with MAU had significantly lower GWI and GWE than those without MAU, and the MAU group had significantly higher GWW compared to the non-MAU group.</p> Conclusions <p>In this study, MAU exacerbated the impairment of LV systolic function in T2DM patients. Myocardial work techniques can serve as a more sensitive clinical method for evaluating LV systolic function in elderly T2DM patients with MAU.</p> Trial registration <p>Chinese Clinical Registry Center, ChiCTR2400094052 (prospectively registered), Date: 12-16-2024.</p>