The presence of higher amounts of myocardial fat is associated with severe cardiac dysfunction in patients with type 2 diabetes, especially the elderly and female patients, according to a recent study published in the journal Cardiovascular Diabetology.¹

Type 2 diabetes patients in whom ECG-gated coronary computed tomography angiography (CCTA) was performed followed by abdominal CT scans within a year at two hospitals in Japan from January 2000 to March 2021 were selected for this retrospective study. The participants had a mean age of 66.6 years, mean BMI 26.2 kg/m2, mean ejection fraction (EF) 67.6% and mean myocardial CT value of 47.7 Hounsfield unit. Presence of myocardial fat was ascertained via CCTA. Through this study, the researchers aimed to define the clinical features of type 2 diabetes patients with myocardial fat accumulation. They also investigated the associations between myocardial fat accumulation and coronary artery disease or myocardial function in type 2 diabetes.

A significant association was noted between mean ejection fraction and myocardial CT value among the 124 patients enrolled for the study indicating that patients with more myocardial fat had more severe left ventricular systolic dysfunction. This association was shown to be independent on multiple regression analyses. Myocardial CT value correlated negatively with BMI, visceral fat area and subcutaneous fat area. No significant correlation was noted between myocardial fat content and glycemic values and TGs.

On subgroup analysis, a strong association was noted between myocardial fat with EF as well as early lateral annular tissue Doppler velocity (Lat e) in patients aged 65 years or older and women study participants as shown by a decrease in Lat e suggestive of left ventricular diastolic dysfunction. Again, the association of myocardial CT value and EF and Lat e was independent. Presence of myocardial fat was also strongly associated with hepatic fat and abdominal obesity. 

This study has for the first time, note the authors, shown a strong association of myocardial fat with both left ventricular diastolic and systolic dysfunction in patients with type 2 diabetes. This association was particularly evident among females and older patients. Based on their findings, the authors suggest reduction of myocardial fat as a “therapeutic target” for patients with type 2 and heart failure.

Reference

1. Kashiwagi-Takayama R, et al. Myocardial fat accumulation is associated with cardiac dysfunction in patients with type 2 diabetes, especially in elderly or female patients: a retrospective observational study. Cardiovasc Diabetol. 2023 Mar 7;22(1):48. doi: 10.1186/s12933-023-01782-y.