Impact of obesity on longitudinal changes to cardiac structure and function in patients with Type 2 diabetes mellitus

Few prospective studies have evaluated the natural progression of left ventricular (LV) remodelling in patients with Type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the impact of obesity on longitudinal cardiac structural and functional changes in patients with T2DM.

This study comprised of 274 patients with T2DM (mean age, 62.2 ± 11.4 years; male, 51.5%). Echocardiographic parameters including LV geometry, systolic, and diastolic functions were measured at baseline and follow-up. The median follow-up was 24 months (from 12 months to 48 months). The entire cohort showed a significant increase in LV wall thickness, LV mass (LVM), and prevalence of concentric hypertrophy (19.6–27.3%). Further, systolic function and diastolic function had deteriorated at follow-up assessment. Multivariable adjusted linear regression demonstrated that baseline body mass index (BMI) predicted longitudinal change to LVM (β  = 0.29, P < 0.01) and LV ejection fraction (β  = −0.15, P < 0.05). Patients were divided into three groups according to their BMI: normal weight (BMI <23 kg/m²), overweight (BMI between 23 kg/m² and 27.5 kg/m²), or obese (BMI ≥27.5 kg/m²). Importantly, obesity at baseline predicted a greater longitudinal increase in LVM and decrease in LV ejection fraction compared with overweight and normal weight patients.

Being obese at baseline was associated with greater longitudinal increase in LV mass and greater deterioration in LV systolic function.