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Epicardial fat and Stage B heart failure among overweight/obese and normal weight individuals with diabetes mellitus

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Abstract

Purpose

Although up to 20% of people with type 2 diabetes (DM) have normal BMI (< 25 kg/m2), it remains unclear whether there is a difference in the development of cardiac dysfunction between those with normal and higher BMI. Furthermore, little is known about the relationship of visceral fat with BMI or fitness in asymptomatic patients with DM.

Methods

We prospectively enrolled asymptomatic patients with DM and divided into two groups: BMI ≥ 25kg/m2 (overweight/obese group) versus < 25kg/m2(normal-weight group). Resting echocardiogram followed by exercise stress echocardiogram and exercise gas exchange analysis (in a subgroup) was performed. Cardiac function was evaluated using left ventricular longitudinal strain (LVLS), E/e’, and relative wall thickness (RWT). In addition, epicardial fat thickness (EFT) was measured to estimate visceral fat.

Results

Normal-weight patients with DM had more EFT compared with overweight/obese patients (0.66 ± 0.17 cm vs. 0.59 ± 0.22 cm, p < 0.05), despite the overlap between the groups. There was no significant difference in the prevalence of LV remodeling (p = 0.49), impaired LVLS (p = 0.22), or increased E/e’ (p = 0.26), and these were consistently observed when matched for race. The majority of patients (63%) achieved ≥ 85% of percent peak-predicted VO2. At peak, there was no significant difference in peak VO2 normalized by eLBM (36.4 ± 7.7 vs. 37.8 ± 7.1 ml/kg eLBM/min, p = 0.43) while VO2 normalized by weight (23.6 ± 6.5 vs. 29.6 ± 6.7 ml/kg/min, p < 0.001) and VO2 ratio (5.7 ± 1.7 vs. 7.3 ± 2.4 METs, p = 0.001) were significantly lower in patients with obese/overweight group. There was no significant difference between patients with higher and lower EFT.

Conclusions

Patients with DM and normal BMI have excess epicardial fat compared to those with overweight/obese. Epicardial fat was not directly linked to prevalence of subclinical dysfunction.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the Stanford Diabetes Research Center P30DK116074, the National Institutes of Health under award number R18DK09639405 and R01DK08137110 as well as the grand from Philips Royal Precision Medicine Initiative.

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    Authors and Affiliations

    1. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

      Yukari Kobayashi, Tomoko Nishi, Jeffery W. Christle, Latha Palaniappan & Francois Haddad

    2. Stanford Cardiovascular Institute, Stanford, CA, USA

      Yukari Kobayashi, Tomoko Nishi, Latha Palaniappan & Francois Haddad

    3. Stanford Sports Cardiology, Stanford University, Stanford, CA, USA

      Jeffery W. Christle

    4. Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, Leuven, Belgium

      Nicholas Cauwenberghs & Tatiana Kuznetsova

    5. Instructor of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA, 94305, USA

      Yukari Kobayashi

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    Contributions

    Y.K. and F.H. conceived and assisted with the design of the study. Y.K., T.N and J.C. performed data curation and Y.K. performed formal data analysis. Y.K. and F.H. interpreted the data and wrote the manuscript. T.N., J.C., N.C., T.K., and L.P. reviewed and revised the manuscript critically for important intellectual content. All authors approved the manuscript.

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    Correspondence to Yukari Kobayashi.

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    Kobayashi, Y., Nishi, T., Christle, J.W. et al. Epicardial fat and Stage B heart failure among overweight/obese and normal weight individuals with diabetes mellitus. Int J Cardiovasc Imaging 39, 2451–2461 (2023). https://doi.org/10.1007/s10554-023-02944-5

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