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Background: Clinical, epidemiologic and pathologic data support the existence of a specific cardiomyopathy associated with diabetes mellitus. However, there has been considerable debate regarding the exact nature and the cause of cardiac dysfunetion attributable to diabetes mellitus. This study was undertaken to compare the clinical characteristics of diabetic cardiomyopathy with those of ischemic cardiomyopathy and of NIDDM overall. Methods: Between May 1989 and August 1994, we studied 82 NIDDM patients with congestive heart failure of new onset who showed systolic dysfunction on echocardiography or gated cardiac blood pool scintigraphy (ejection fraction 45%). Forty-five patients who showed regional LV dysfunction were first classified into the ischemic cardiomyopathy group. Remaining 37 patients underwent coronary angiography or thallium scintigraphy. Ten patients had evidence of significant stenosis of coronary arteries and were further classified into the ischemic cadiomyopathy group, and the remaining 27 patients were classified as having diabetic cardiomyopathy. We compared the clinical characterristics of these two groups of patients and those of 670 consecutive NIDDM patients who attended the diabetic clinic of Asan Medical Center during 3 months period. Results: Among 27 patients with diabetic cardiomyopathy, 11 were male and 16 were female. Their mean age was 61.3 years (range 45~84). Known diabetic duration of diabetes ranged from 1 to 30 years. Diabetic retinopathy was found in 2l out of 26 patients (81%) of diabetic cardiomyopathy. Eight of them had proliferative retinapathy. Twenty-three out of 27 (85%) patients of diabetic cardiomyopathy had diabetic nephropathy. Microalbuminuria, overt proteinuria and chronic renal failure was found in 4, 7 and 12 patients, respectively. Diabetic neuropathy was found in 12 out of 15 patients (80%) of diabetic cardiomyopathy. Prevalence of microvaseular complications in diabetic cardiomyopathy group was higher than that in ischemic cardiomyopathy group or NIDDM overall. Maerovascular complications (cerebrovascular and leg vascular disease) were found in 2 out of 27 patients (8%) of the patients with diabetic cardiomyopathy, and this frequency was not different from that in ischemic cardiomyopathy group or NIDDM patients overall. Conclusion: Prevalence of microvascular complications in diabetic cardiomyopathy was higher than that in ischemic cardiomyopathy or NIDDM overall. This suggest that similar pathogemic mechanism may be involved in the development of diabetic cardiomyopathy and microvascular complications.