TY - JOUR
T1 - Relationship of Cardiac Structure and Function to Cardiorespiratory Fitness and Lean Body Mass in Adolescents and Young Adults with Type 2 Diabetes
AU - Bacha, Fida
AU - Gidding, Samuel S.
AU - Pyle, Laura
AU - Levitt Katz, Lorraine
AU - Kriska, Andrea
AU - Nadeau, Kristen J.
AU - Lima, Joao A.C.
N1 - Funding Information:
Funded by The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health Office of the Director (U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254); the National Center for Research Resources General Clinical Research Centers (M01-RR00036 [to Washington University School of Medicine], M01-RR00043-45 [to Children's Hospital Los Angeles], M01-RR00069 [to University of Colorado Denver], M01-RR00084 [to Children's Hospital of Pittsburgh], M01-RR01066 [to Massachusetts General Hospital], M01-RR00125 [to Yale University], and M01-RR14467 [to University of Oklahoma Health Sciences Center]); and the National Center for Research Resources Clinical and Translational Science Awards (UL1-RR024134 [to Children's Hospital of Philadelphia], UL1-RR024139 [to Yale University], UL1-RR024153 [to Children's Hospital of Pittsburgh], UL1-RR024989 [to Case Western Reserve University], UL1-RR024992 [to Washington University in St Louis], UL1-RR025758 [to Massachusetts General Hospital], and UL1-RR025780 [to University of Colorado Denver]).
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016
Y1 - 2016
N2 - Objective To investigate the relationships of cardiac structure and function with body composition and cardiorespiratory fitness (CRF) among adolescents with type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study. Study design Cross-sectional evaluation of 233 participants (median age 18.3 [min-max 12.4-24.2] years, 63% females, median hemoglobin A1c 6.8%) who had echocardiography measurements of left ventricular (LV) mass, ejection fraction, left atrial dimensions, LV diastolic function (early transmitral flow velocity to early mitral annular velocity ratio from tissue Doppler imaging), and right ventricular function (tricuspid annular plane systolic excursion [TAPSE]) and body composition (dual-energy x-ray absorptiometry) and CRF (cycle ergometry determination of physical work capacity at heart rate of 170 beats per minute). Results LV mass correlated positively with CRF (r = 0.5, P < .0001), lean body mass (LBM) (r = 0.7, P < .0001), and fat mass (FM) (r = 0.2, P = .00047); LV ejection fraction did not. Early transmitral flow velocity to early mitral annular velocity was positively related to FM (r = 0.14, P = .03) and % body fat (r = 0.18, P = .007), and left atrial internal diameter correlated with FM (r = 0.4, P < .0001), LBM (r = 0.3, P < .001), and CRF (r = 0.2, P = .0033). TAPSE weakly correlated with CRF (r = 0.2, P = .0014) and LBM (r = 0.13, P < .05) but not with FM. In multivariable regression analyses, LBM (β = 2.13, P < .0001) and CRF (β = 0.023, P = .008) were related to LV mass independent of race, sex, age, hemoglobin A1c, hypertension, smoking, and diabetes medications. CRF (β = 0.0002, P = .0187) and hemoglobin A1c (β = −0.022, P = .0142) were associated with TAPSE. Conclusions In youth with type 2 diabetes, LV size is related to physical fitness. LV ejection fraction is within normal limits. LV diastolic function is inversely related to FM. Greater fitness may counteract adverse effects of poor glycemic control on right ventricular function. Trial registration ClinicalTrials.gov:
AB - Objective To investigate the relationships of cardiac structure and function with body composition and cardiorespiratory fitness (CRF) among adolescents with type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study. Study design Cross-sectional evaluation of 233 participants (median age 18.3 [min-max 12.4-24.2] years, 63% females, median hemoglobin A1c 6.8%) who had echocardiography measurements of left ventricular (LV) mass, ejection fraction, left atrial dimensions, LV diastolic function (early transmitral flow velocity to early mitral annular velocity ratio from tissue Doppler imaging), and right ventricular function (tricuspid annular plane systolic excursion [TAPSE]) and body composition (dual-energy x-ray absorptiometry) and CRF (cycle ergometry determination of physical work capacity at heart rate of 170 beats per minute). Results LV mass correlated positively with CRF (r = 0.5, P < .0001), lean body mass (LBM) (r = 0.7, P < .0001), and fat mass (FM) (r = 0.2, P = .00047); LV ejection fraction did not. Early transmitral flow velocity to early mitral annular velocity was positively related to FM (r = 0.14, P = .03) and % body fat (r = 0.18, P = .007), and left atrial internal diameter correlated with FM (r = 0.4, P < .0001), LBM (r = 0.3, P < .001), and CRF (r = 0.2, P = .0033). TAPSE weakly correlated with CRF (r = 0.2, P = .0014) and LBM (r = 0.13, P < .05) but not with FM. In multivariable regression analyses, LBM (β = 2.13, P < .0001) and CRF (β = 0.023, P = .008) were related to LV mass independent of race, sex, age, hemoglobin A1c, hypertension, smoking, and diabetes medications. CRF (β = 0.0002, P = .0187) and hemoglobin A1c (β = −0.022, P = .0142) were associated with TAPSE. Conclusions In youth with type 2 diabetes, LV size is related to physical fitness. LV ejection fraction is within normal limits. LV diastolic function is inversely related to FM. Greater fitness may counteract adverse effects of poor glycemic control on right ventricular function. Trial registration ClinicalTrials.gov:
KW - body composition
KW - echocardiography
KW - fitness
KW - left ventricular function
KW - right ventricular function
KW - type 2 diabetes
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U2 - 10.1016/j.jpeds.2016.06.048
DO - 10.1016/j.jpeds.2016.06.048
M3 - Article
C2 - 27499218
AN - SCOPUS:84998882018
SN - 0022-3476
VL - 177
SP - 159-166.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -