Diabetes mellitus (DM) is a serious threat to human health and life. It can lead to a variety of complications [
1‐
3]. Among all the complications of DM, cardiovascular complications are important causes of disability and death [
4], and diabetic nephropathy (DN) is the major cause of end-stage renal failure. Renal disease is also an important cause of cardiovascular disease (CVD), including sudden cardiac death and stroke [
5,
6]. Thus, DN patients have a high risk of CVD, which is identified as the leading reason of death in these patients.
It was reported that stiffness in arteries was a major and robust independent predictor of CVD [
7,
8]. Arterial stiffness was recommended as a proof of damage to the target organs in the European guidelines for the hypertension diagnosis and treatment [
9]. There are several methods of evaluating arterial stiffness, such as vascular catheterization, ultrasound, magnetic resonance imaging [
10], and arterial tonometry [
11]. 2D-STE (two-dimensional speckle-tracking strain echocardiography) is a useful technology that has been developed in recent years [
12,
13]. It is an accurate, angle-independent, and noninvasive method for evaluating cardiac function [
14]. It can be used to obtain myocardial deformation by tracking intramyocardial speckles, accordingly calculating the strain (S) and strain rate (Sr) of the myocardium [
15]. This strain-based imaging technique has been shown to have clinical utility in a variety of settings [
16]. It can predict severe coronary artery disease (CAD) in women with normal LV function [
17]. It can be used to identify the ischemic etiology of LV systolic dysfunction [
18]. The study by Atici et al. showed that GLS (global longitudinal strain) evaluated through 2D-STE is a potential method for predicting CAD in patients with non-ST-segment elevation myocardial infarction [
19]. 2D-STE can assess the impairment of left atrial phasic function in patients with heart failure with mid-range ejection fraction (EF) [
20]. At present, this technique is also used to evaluate the elasticity of the carotid artery, and the obtained strain has a good correlation with carotid elasticity [
21]. The aortic circumferential strain and the rate of strain estimated by 2D strain imaging enable accurate and simple evaluation of the stiffness of the aorta [
22]. However, the relationship between the elasticity of the carotid artery and the systolic function of the LV remains unclear. The study aimed to examine the association between carotid elasticity and LV systolic function in DN patients using 2D-STE.