Catherine Kelly

Charalambos Antoniades

Chris Rodgers

Eylem Levelt

Jane M Francis

Joanne Sellwood

Jurgen E Schneider

Kieran Clarke

Masliza Mahmod

Michael Pavlides

Nikant Sabharwal

Oliver Rider

Sheena Thomas

Stefan Neubauer

Theodoros D Karamitsos

William T Clarke

Journal of Cardiovascular Magnetic Resonance

Springer - Publisher Connector

Cardiac and hepatic phenotype of diabetes in the presence and the absence of obesity - mechanistic role of ectopic/visceral adiposity

POSTER PRESENTATION Open Access
Cardiac and hepatic phenotype of diabetes in
the presence and the absence of obesity -
mechanistic role of ectopic/visceral adiposity
Eylem Levelt1,4*, Michael Pavlides1, Masliza Mahmod1, Catherine Kelly2, Joanne Sellwood1, Sheena Thomas3,
Jane M Francis1, Jurgen E Schneider1, Chris Rodgers1, William T Clarke1, Nikant Sabharwal3,
Charalambos Antoniades3, Kieran Clarke4, Theodoros D Karamitsos1, Oliver Rider1, Stefan Neubauer1
From 19th Annual SCMR Scientific Sessions
Los Angeles, CA, USA. 27-30 January 2016
Background
Ectopic/visceral adiposity is frequently observed in type
2 diabetes mellitus (T2DM) and is linked to cardiovas-
cular mortality. Non-alcoholic fatty liver disease
(NAFLD) is an example of ectopic fat accumulation in a
visceral organ, also strongly linked with cardiovascular
mortality. We assessed the diabetes-associated cardiac
and hepatic changes, and hypothesised that they will be
amplified by the co-existence of obesity, and that the
ectopic adiposity may play a pathophysiological role in
the cardiac and hepatic phenotype of diabetes.
Methods
Twenty-seven obese T2DM (O-T2DM) patients, fifteen
lean T2DM (L-T2DM) patients, and twelve healthy
volunteers were studied. T2DM patients underwent car-
diac CT (epicardial fat quantification and exclusion of
significant CAD), cardiac MRI (cine and tagging), 1H-,
31P-MRS for myocardial triglyceride (MTG) and PCr/
ATP respectively, and a multi-parametric liver MRI
scan, including 1H-MRS for hepatic triglyceride (HTG),
T1 and T2* mapping yielding an ‘iron-corrected T1’
(cT1), a parameter which allows non-invasive quantifica-
tion of fibroinflammatory liver disease. Healthy volun-
teers underwent identical MRI protocols.
Results
Demographic, biochemical and multiparametric MRI
results are provided in Figure 1.
When comparing L-T2DM to controls, diabetes, even
in the absence of obesity, was associated with increased
LV mass (p=0.03), impaired myocardial energetics
(p=0.04), increased MTG (p=0.01) and HTG (p=0.04).
While cardiac structural changes, and abnormalities in
MTG and PCr/ATP were similar between the two
T2DM groups, epicardial fat volumes (p=0.04) and HTG
(p=0.01) were significantly increased in O-T2DM
patients compared to L-T2DM. Moreover, HTG and
epicardial fat volumes correlated negatively with the
peak systolic circumferential strain and diastolic strain
rates (Figure 2 for all), and in line with this, these func-
tional changes were only impaired in O-T2DM patients
(p < 0.001 and p = 0.006 respectively compared to con-
trols), supporting a potential mechanistic role of ectopic
adiposity for cardiac dysfunction in T2DM. MTG did
not correlate with HTG or epicardial fat volumes.
Finally, fibroinflammatory liver disease (elevated cT1)
was also only evident in O-T2DM (p=0.004 and p <
0.001 vs L-T2DM patients and controls, respectively),
and liver cT1 also correlated with HTG and epicardial
fat volumes (p < 0.001 and p = 0.01 respectively).
Conclusions
We demonstrate here, for the first time, not only that
ectopic adiposity is more pronounced in obese compared
to lean T2DM patients, but that it is also linked to car-
diac contractile dysfunction and fibroinflammatory liver
disease. However, myocardial steatosis is not associated
with epicardial/hepatic adiposity, and may thus represent
a separate entity influenced by factors beyond ectopic
adiposity. Ectopic adiposity represents an important ther-
apeutic target, and the reversal of body fat distribution
1OCMR, University of Oxford, Oxford, United Kingdom
Full list of author information is available at the end of the article
Levelt et al. Journal of Cardiovascular Magnetic
Resonance 2016, 18(Suppl 1):P224
http://www.jcmr-online.com/content/18/S1/P224
© 2016 Levelt et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/
zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Figure 1 Correlations of HTG and epicardial fat volumes with circumferential systolic and diastolic rates.
Table 1 Demographic, biochemical and multiparametric MRI results.
Controls N=12 Lean T2DM patients N=15 Obese T2DM patients N=27 P value
Age, y 50 ± 10 56 ± 9 56 ± 8 0.16
BMI, kg/m2 23 ± 3 23 ± 2 33 ± 3* <0.001
Male,% 58 60 41 0.41
Diabetes Duration, years ... 6.1 ± 4.7 6.6 ± 6.5 0.78
Glycated hemoglobin, % ... 7.4 ± 0.9 7.7 ± 1.4 0.22
ALT, IU/L 22 ± 9 30 ± 22 36 ± 17 0.12
Multiparametric Liver MRI
cT1,ms 753 ± 45 821 ± 67 924 ± 116* <0.001
Hepatic triglyceride content, % (Lipid/water ratio) 3.6 ± 3.5 7.7 ± 4.6 14.8 ± 8.4* <0.001
CMR and Cardiac MRS Findings
LV end-diastolic volume, ml 145 ± 40 124 ± 33 126 ± 25 0.15
LV mass, g 98 ± 26 123 ± 33† 119 ± 28† 0.01
LV mass to LV end-diastolic volume, g/ml 0.63 ± 0.13 0.95 ± 0.26 0.89 ± 0.20 <0.001
Peak systolic circumferential strain, negative (-),% 18.1 ± 2.1 16.5 ± 2.6† 13.4 ± 3.6* <0.001
Peak circumferential diastolic strain rate, s-1 74 ± 20 68 ± 19* 56 ± 26† 0.006
Mycocardial PCr/ATP ratio 2.08 ± 0.40 1.75 ± 0.29* 1.64 ± 0.32* 0.003
Mycocardial triglyceride, %(Lipid/water ratio) 0.48 ± 0.28 1.14 ± 0.66† 1.22 ± 0.91† 0.02
Values are mean ± standard deviations or percentages. T2DM indicates type 2 diabetes mellitus; CMR, cardiac magnetic resonancel cT1, corrected T1; ms,
milliseconds; PCr, Phs phocreatine *p < 0.05 vs controls and lean T2Dm †p < 0.05 vs controls
Levelt et al. Journal of Cardiovascular Magnetic
Resonance 2016, 18(Suppl 1):P224
http://www.jcmr-online.com/content/18/S1/P224
Page 2 of 3
abnormalities may improve cardiac function and prog-
nosis in patients with diabetes.
Authors’ details
1OCMR, University of Oxford, Oxford, United Kingdom. 2Perspectum
Diagnostics Ltd, Oxford, United Kingdom. 3Division of Cardiovascular
Medicine, John Radcliffe Hospital, Oxford, United Kingdom,. 4Department of
Physiology, Anatomy & Genetics, University of Oxford, Oxford, United
Kingdom.
Published: 27 January 2016
doi:10.1186/1532-429X-18-S1-P224
Cite this article as: Levelt et al.: Cardiac and hepatic phenotype of
diabetes in the presence and the absence of obesity - mechanistic role
of ectopic/visceral adiposity. Journal of Cardiovascular Magnetic Resonance
2016 18(Suppl 1):P224.
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Levelt et al. Journal of Cardiovascular Magnetic
Resonance 2016, 18(Suppl 1):P224
http://www.jcmr-online.com/content/18/S1/P224
Page 3 of 3


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Cardiac and hepatic phenotype of diabetes in the presence and the absence of obesity - mechanistic role of ectopic/visceral adiposity

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