Negative synergism of diabetes mellitus and obesity in patients with heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study

In patients with heart failure with preserved ejection fraction (HFpEF), diabetes mellitus (DM) and obesity are important comorbidities as well as major risk factors. Their conjoint impact on the myocardium provides insight into the HFpEF aetiology. We sought to investigate the association between obesity, DM, and their combined effect on alterations in the myocardial tissue in HFpEF patients. One hundred and sixty-two HFpEF patients (55 +/- 12 years, 95 men) and 45 healthy subjects (53 +/- 12 years, 27 men) were included. Patients were classified according to comorbidity prevalence (36 obese patients without DM, 53 diabetic patients without obesity, and 73 patients with both). Myocardial remodeling, fibrosis, and longitudinal contractility were quantified with cardiovascular magnetic resonance imaging using cine and myocardial native T(1)images. Patients with DM and obesity had impaired global longitudinal strain (GLS) and increased myocardial native T(1)compared to patients with only one comorbidity (DM + Obesity vs. DM and Obesity; GLS, - 15 +/- 2.1 vs - 16.5 +/- 2.4 and - 16.7 +/- 2.2%; native T-1, 1162 +/- 37 vs 1129 +/- 25 and 1069 +/- 29 ms; P < 0.0001 for all). A negative synergistic effect of combined obesity and DM prevalence was observed for native T-1(np(2) = 0.273, p = 0.002) and GLS (np(2) = 0.288, p < 0.0001). Additionally, severity of insulin resistance was associated with GLS (R = 0.590, P < 0.0001), and native T-1(R = 0.349, P < 0.0001). The conjoint effect of obesity and DM in HFpEF patients is associated with diffuse myocardial fibrosis and deterioration in GLS. The negative synergistic effects observed on the myocardium may be related to severity of insulin resistance.