Epicardial adipose tissue linked to exercise capacity in adults with type 2 diabetes, asymptomatic HF
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Exercise may be more difficult for those with type 2 diabetes and asymptomatic heart failure than those without these conditions due to more epicardial adipose tissue and abnormalities in the structure and function of the left ventricle, according to findings published in the Journal of Diabetes and its Complications.
“Left ventricular structure and function are important determinants of exercise capacity,” Yousuke Sugita, of the faculty of health sciences at Tsukuba University of Technology and the department of cardiology at the Sakurai Clinic in Japan, and colleagues wrote. “With the viewpoint of preventing the aggravation of heart failure (HF), clarifying the factors related to myocardial dysfunction and exercise intolerance at the asymptomatic stage is important, even in type 2 diabetes patients who are at a high risk of developing HF.”
Sugita and colleagues used data from 176 adults with type 2 diabetes and stage A or stage B asymptomatic HF (mean age, 65.1 years; 48.9% women) and 62 adults without either condition (mean age, 64.1 years; 48.4% women) to evaluate amounts of epicardial adipose tissue and exercise capacity. The researchers used echocardiography to determine the amount of epicardial adipose tissue as well as the structural and functional characteristics of the left ventricle. The researchers had participants complete a cardiopulmonary exercise test to ascertain exercise capacity as measured by peak oxygen uptake and peak exercise heart rate.
Participants with stage B asymptomatic HF had a mean epicardial adipose tissue thickness of 9.3 mm vs. a thickness of 6.4 mm for those with stage A asymptomatic HF and a thickness of 5.5 mm for those without diabetes or asymptomatic HF (P = .001). Conversely, participants with stage B asymptomatic HF had mean peak oxygen uptake of 16.9 mL/kg per minute and mean heart rate at peak exercise of 118.7 beats per minute vs. measures of 19.1 mL/kg per minute and 131 beats per minute for those with stage A asymptomatic HF and 24.1 mL/kg per minute and 161.4 beats per minute for those without diabetes or asymptomatic HF (P = .001 for all).
“This new finding has clinical significance because a decline in exercise capacity is an independent risk of worse life prognosis and the onset of HF in type 2 diabetes patients,” the researchers wrote.
The researchers also noted that there were greater measures of epicardial adipose tissue thickness and reduced measures of peak oxygen uptake with rising numbers of structural or functional abnormalities in the left ventricle which “tended to be worse” with more severe asymptomatic HF.
“The findings of this cross-sectional study of type 2 diabetes patients with asymptomatic HF suggested that epicardial adipose tissue may be independently associated with exercise capacity indicators,” the researchers wrote. “The findings also suggested that part of the relationship between epicardial adipose tissue and exercise capacity may involve the heart rate response and myocardial contractility.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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