Increased epicardial adipose tissue is associated with reduced cardiac function and severe retinopathy in type 2 diabetes

Epicardial fat is known to be elevated in patients with type 2 diabetes mellitus (T2DM), but the clinical significance of this fat deposition is not fully understood.

We assessed the epicardial adipose tissue in patients with T2DM and diabetic retinopathy (DR) without history of cardiovascular disease (CVD) when compared to healthy controls, and assessed the associations with cardiac function and severity of retinopathy.

101 T2DM patients without history of CVD who underwent eye assessment for stages of retinopathy and 92 healthy controls underwent magnetic resonance imaging (MRI) for the assessment of epicardial & pericardial adipose tissue, cardiac function (left ventricular ejection fraction – LVEF, and strain), native T1 mapping, liver fat and liver iron corrected T1 (cT1).

When compared to controls, DR had increased epicardial adipose tissue, lower LVEF, indexed LV end-diastolic & stroke volumes, impaired global longitudinal & circumferential strains, increased myocardial T1, liver fat and liver cT1 (all adjusted for age, gender and BMI). There were no significant differences in left atrial size, LV wall thickness, pericardial fat in DR, compared to controls after adjustment for age, gender and BMI. Increased epicardial fat was associated with reduced global longitudinal strain and severe (proliferative) retinopathy.

Patients with T2DM and retinopathy have elevated epicardial fat which is associated with reduced cardiac function, and presence of advanced retinopathy. T2DM with retinopathy without history of CVD may have underlying cardiac diseases and therefore should be considered for further cardiac evaluation. Epicardial fat may be a potential risk marker and therapeutic target in T2DM.

Demographics and MRI parameters