Epicardial adipose tissue is tightly associated with exercise intolerance in patients with type 2 diabetes mellitus with asymptomatic left ventricular structural and functional abnormalities

Sugita, Yousuke; Ito, Katsuhiko; Sakurai, Shigeki; Sakai, Satoshi; Kuno, Shinya

doi:10.1016/j.jdiacomp.2020.107552

Cited by 12 publications

(12 citation statements)

References 34 publications

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“…Recent studies showed the negative effects of acute hyperglycemia on systolic LV global longitudinal strain and multilayer longitudinal and circumferential strain in asymptomatic T2DM and unfavorable subclinical reductions in global and average circumferential strain in obese adolescents with dysglycemia, which may indicate the importance of intensive blood glucose control [24,25]. Moreover, epicardial adipose tissue may be associated with LV structural and functional abnormalities and exercise intolerance in T2DM patients with asymptomatic heart failure [26], and serum levels of omentin-1 and Zinc-α2-glycoprotein have been recently defined as the most important predictors for LV hypertrophy and LV diastolic dysfunction in T2DM patients [27]. Our study demonstrated that T2DM aggravated LV systolic dysfunction as represented by more severe impairment of GLPS and GRPS and the occurrence of impaired GCPS in the HTN (T2DM+) group, even though similar LVEF and LV geometries were observed between the hypertensive subgroups.…”

Section: Table 4 Multivariable Association Of Diabetes With First-pasmentioning

confidence: 99%

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study

Jiang

Guo

et al. 2020

Cardiovasc Diabetol

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Background Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals. Materials and methods Seventy hypertensive patients without T2DM [HTN(T2DM−)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni’s post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension. Results Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM−), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM−) and control groups. Compared with controls, HTN(T2DM−) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM−) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p = 0.002, model R2= 0.383; GCPS: p < 0.001, model R2= 0.472; and GLPS: p = 0.002, model R2= 0.424, respectively) and perfusion indices (upslope: p < 0.001, model R2= 0.293; TTM: p < 0.001, model R2= 0.299; and MaxSI: p < 0.001, model R2= 0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p = 0.044 and 0.017, model R2= 0.390) and GCPS (p = 0.002 and 0.001, model R2= 0.424), and T2DM but not perfusion indices was independently associated with GLPS (p = 0.002, model R2= 0.424). Conclusion In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.

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Section: Table 4 Multivariable Association Of Diabetes With First-pasmentioning

confidence: 99%

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study

Jiang

Guo

et al. 2020

Cardiovasc Diabetol

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“…99 In a cross-sectional study (n = 176 T2DM patients with asymptomatic HF and 62 healthy controls; EAT thickness measured using TTE; peak oxygen uptake [peakVO2] was measured using cardiopulmonary exercise testing), peak VO2 was associated with EAT thickness (β = −0.207, P = 0.004), using multiple regression analysis. 100 EAT was thicker in healthy control compared with T2DM patients with asymptomatic HF (5.5 ± 1.2 vs 9.3 ± 1.0 mm, respectively, P < 0.001). Sugita et al 100 concluded that EAT may be associated with exercise intolerance, LV functional and structural abnormalities.…”

Section: Eat and Pat As Predictors Of Cvd Riskmentioning

confidence: 89%

“…100 EAT was thicker in healthy control compared with T2DM patients with asymptomatic HF (5.5 ± 1.2 vs 9.3 ± 1.0 mm, respectively, P < 0.001). Sugita et al 100 concluded that EAT may be associated with exercise intolerance, LV functional and structural abnormalities. Endoplasmic reticulum stress (which could be linked to both, physiological and pathological states in the CV system) and autophagy pathways in EAT might be associated with heart disease (e.g.…”

Section: Eat and Pat As Predictors Of Cvd Riskmentioning

confidence: 89%

Can We Decrease Epicardial and Pericardial Fat in Patients With Diabetes?

Muzurović

Vujosevic

Mikhailidis

2021

J Cardiovasc Pharmacol Ther

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Diabetes mellitus (DM) is a chronic and complex metabolic disorder and also an important cause of cardiovascular (CV) disease (CVD). Patients with type 2 DM (T2DM) and obesity show a greater propensity for visceral fat deposition (and excessive fat deposits elsewhere) and the link between adiposity and CVD risk is greater for visceral than for subcutaneous (SC) adipose tissue (AT). There is growing evidence that epicardial AT (EAT) and pericardial AT (PAT) play a role in the development of DM-related atherosclerosis, atrial fibrillation (AF), myocardial dysfunction, and heart failure (HF). In this review, we will highlight the importance of PAT and EAT in patients with DM. We also consider therapeutic interventions that could have a beneficial effect in terms of reducing the amount of AT and thus CV risk. EAT is biologically active and a likely determinant of CV morbidity and mortality in patients with DM, given its anatomical characteristics and proinflammatory secretory pattern. Consequently, modification of EAT/PAT may become a therapeutic target to reduce the CV burden. In patients with DM, a low calorie diet, exercise, antidiabetics and statins may change the quantity of EAT, PAT or both, alter the secretory pattern of EAT, improve the metabolic profile, and reduce inflammation. However, well-designed studies are needed to clearly define CV benefits and a therapeutic approach to EAT/PAT in patients with DM.

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“…Recent studies showed the negative effects of acute hyperglycemia on systolic LV global longitudinal strain and multilayer longitudinal and circumferential strain in asymptomatic T2DM and unfavorable subclinical reductions in global and average circumferential strain in obese adolescents with dysglycemia, which may indicate the importance of intensive blood glucose control [24,25]. Moreover, epicardial adipose tissue may be associated with LV structural and functional abnormalities and exercise intolerance in T2DM patients with asymptomatic heart failure [26], and serum levels of omentin-1 and Zinc-α2-glycoprotein have been recently de ned as the most important predictors for LV hypertrophy and LV diastolic dysfunction in T2DM patients [27]. Our study demonstrated that T2DM aggravated LV systolic dysfunction as represented by more severe impairment of GLPS and GRPS and the occurrence of impaired GCPS in the HTN (T2DM+) group, even though similar LVEF and LV geometries were observed between the hypertensive subgroups.…”

Section: T2dm Aggravate LV Dysfunction In Hypertensionmentioning

confidence: 99%

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0T cardiac magnetic resonance study

Jiang

Guo

et al. 2020

Preprint

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Background: Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals.Materials and Methods: Seventy hypertensive patients without T2DM [HTN(T2DM-)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni’s post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension.Results: Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM-), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM-) and control groups. Compared with controls, HTN(T2DM-) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM-) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p=0.002, model R2=0.383; GCPS: p<0.001, model R2=0.472; and GLPS: p=0.002, model R2=0.424, respectively) and perfusion indices (upslope: p<0.001, model R2=0.293; TTM: p<0.001, model R2=0.299; and MaxSI: p<0.001, model R2=0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p=0.044 and 0.017, model R2=0.390) and GCPS (p=0.002 and 0.001, model R2=0.424), and TTM but not perfusion indices was independently associated with GLPS (p=0.002, model R2=0.424). Conclusion: In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.

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Epicardial adipose tissue is tightly associated with exercise intolerance in patients with type 2 diabetes mellitus with asymptomatic left ventricular structural and functional abnormalities

Cited by 12 publications

References 34 publications

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study

Can We Decrease Epicardial and Pericardial Fat in Patients With Diabetes?

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0T cardiac magnetic resonance study

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