Epicardial adipose tissue is associated with exercise intolerance in patients with diabetes with asymptomatic left ventricular structural and functional abnormalities

The volume of epicardial adipose tissue (EAT), which is an index of visceral fat, is high in patients with type 2 diabetes mellitus (T2DM) and may affect the myocardial performances. However, the association between EAT and left ventricular (LV) structure and function, and exercise capacity in patients with asymptomatic heart failure has not been studied.

To elucidate whether the volume of EAT deteriorates the exercise capacity in patients with T2DM.

EAT thickness and LV structural and functional abnormality components (e.g., global longitudinal strain, E/e', LV mass index, relative wall thickness) were measured with echocardiography in 176 patients with asymptomatic heart failure (Stage A and B) and 62 healthy controls (HC). To evaluate exercise capacity, peak oxygen uptake (peakVO2) was measured by using the cardiopulmonary exercise testing.

Lipid metabolism, glucose metabolism, brain natriuretic peptide and estimated glomerular filtration rate at cystatin were worse in the heart failure (HF) group than in the HC. The EAT was significantly thicker and peakVO2 was lower in patients with LV structural and functional abnormalities than in individuals without these abnormalities (p<0.001). As the number of LV structural and functional abnormality components increased, the thickness of the EAT increased and peakVO2 decreased (p<0.001). The EAT thickness (β=−0.207) was negatively correlated with peakVO2, even after adjusting for multivariates (R2=0.724).

In patients with T2DM with asymptomatic heart failure, EAT is associated with LV structural and functional abnormalities. It also suggests that increase of visceral fat around myocardium contributes to exercise intolerance.

Type of funding sources: Public Institution(s). Main funding source(s): National University Corporation Tsukuba University of Technology education and research Grant