Associations of aortic stiffness and intra-aortic flow parameters with epicardial adipose tissue in patients with type-2 diabetes

Khaoula Bouazizi; Mohamed Zarai; Abdallah Noufaily; Mikaël Prigent; Thomas Dietenbeck; Emilie Bollache; Toan Nguyen; Valéria Della Valle; Eléonore Blondiaux; Karine Clément; Judith Aron-Wisnewsky; Fabrizio Andreelli; Alban Redheuil; Nadjia Kachenoura

doi:10.3389/fcdhc.2023.1106342

Associations of aortic stiffness and intra-aortic flow parameters with epicardial adipose tissue in patients with type-2 diabetes

Front Clin Diabetes Healthc. 2023 May 26:4:1106342. doi: 10.3389/fcdhc.2023.1106342. eCollection 2023.

Authors

Khaoula Bouazizi^{1

2}, Mohamed Zarai², Abdallah Noufaily³, Mikaël Prigent², Thomas Dietenbeck^{1

2}, Emilie Bollache^{1

2}, Toan Nguyen⁴, Valéria Della Valle⁴, Eléonore Blondiaux⁴, Karine Clément^{5

6}, Judith Aron-Wisnewsky^{5

6}, Fabrizio Andreelli^{2

7}, Alban Redheuil^{1

2

3}, Nadjia Kachenoura^{1

2}

Affiliations

¹ Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France.
² ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
³ Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), Pitié-Salpêtrière Hospital, Paris, France.
⁴ Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France.
⁵ Sorbonne Université, INSERM, Nutrition and Obesities; approches systémiques (NutriOmique), Pitié-Salpêtrière Hospital, Nutrition Department, Paris, France.
⁶ Assistance Publique Hôpitaux de Paris, Nutrition Department, Centre de Recherche en Nutrition Humaine (CRNH) Ile-de-France, Pitié-Salpêtrière Hospital, Paris, France.
⁷ Assistance Publique Hôpitaux de Paris, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France.

Abstract

Background: It has been shown that increased aortic stiffness is related to type-2 diabetes (T2D) which is considered as a risk factor for cardiovascular disease. Among other risk factors is epicardial adipose tissue (EAT) which is increased in T2D and is a relevant biomarker of metabolic severity and adverse outcome.

Purpose: To assess aortic flow parameters in T2D patients as compared to healthy individuals and to evaluate their associations with EAT accumulation as an index of cardiometabolic severity in T2D patients.

Materials and methods: Thirty-six T2D patients as well as 29 healthy controls matched by age and sex were included in this study. Participants had cardiac and aortic MRI exams at 1.5 T. Imaging sequences included cine SSFP for left ventricle (LV) function and EAT assessment and aortic cine and phase-contrast imaging for strain and flow parameters quantification.

Results: In this study, we found LV phenotype to be characterized by concentric remodeling with decreased stroke volume index despite global LV mass within a normal range. EAT was increased in T2D patients compared to controls (p<0.0001). Moreover, EAT, a biomarker of metabolic severity, was negatively correlated to ascending aortic (AA) distensibility (p=0.048) and positively to the normalized backward flow volume (p=0.001). These relationships remained significant after further adjustment for age, sex and central mean blood pressure. In a multivariate model, presence/absence of T2D and AA normalized backward flow (BF) to forward flow (FF) volumes ratio are both significant and independent correlates of EAT.

Conclusion: In our study, aortic stiffness as depicted by an increased backward flow volume and decreased distensibility seems to be related to EAT volume in T2D patients. This observation should be confirmed in the future on a larger population while considering additional biomarkers specific to inflammation and using a longitudinal prospective study design.

Keywords: aortic flow; cardiometabolic disease; cardiovascular MRI; epicardiac adipose tissue; type 2 diabetes.

Grants and funding

This project was supported by EU-FP7 Metacardis (http://www.metacardis.net/). MRI acquisitions were funded by the Institute of Cardiometabolism and Nutrition (ICAN) (https://ihuican.org/). This work was partly funded by the Fondation de l’Avenir (https://www.fondationdelavenir.org/).