Diabetes is commonly associated with changes in cardiac structure and function, even in the absence of epicardial atherosclerotic disease. The exact cause of these non-atheroscelrotic cardiac changes is not exactly known (1). In view of the recently reported favorable metabolic effects of ghrelin in type 2 diabetes (2), and also the reports of its beneficial effects in several cardiovascular disorders (3), we assessed fasting serum ghrelin concentrations in 26 diabetics of type 2 with asymptomatic left ventricular structural and functional changes (study group) and 26 age and sex matched subjects having type 2 diabetes without left ventricular structural and functional changes (control group). Both groups were assessed for clinical characteristics, metabolic (lipid profile and fasting blood glucose (FBG) and hormonal parameters (serum leptin, ghrelin and insulin levels), ECG was performed and QTc dispersion (QTcd) was calculated for detection of cardiac autonomic neuropathy and the following LV structural and functional parameters were assessed by two-dimensional echocardiography: left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness, (PWT), interventricular septal thickness at end-diastole (IVST), left ventricular mass index in gm/m2 (LVMI, E/A ratio, ejection fraction, Comparing the related parameters in the 2 groups was done by t-test.. Results showed that no significant difference was found as regarding clinical and lipid profile parameters. Study group was found to have significantly higher levels of FBG, leptin and insulin, while fasting serum ghrelin levels were significantly lower in this group of patients. Statistically significant correlations were found between both leptin and ghrelin, with FBG, insulin, QTcd, and all echocardiographic LV structural and functional parameters. In conclusion, left ventricular structural and functional changes among type 2 diabetics are associated with decreased serum levels of ghrelin, and higher levels of serum glucose, insulin and leptin. These data infer that ghrelin might have a cardioprotective effect in patients with diabetes type.