Diabetes-related differences in body composition and their prognostic value among patients with heart failure and preserved ejection fraction: a cardiac-MRI-based study
Authors' conclusion
Concomitant diabetes exacerbated paracardial adipose excess among HFpEF patients and worsened the association between body composition and adverse outcomes.
Study context
- Population
- Patients with heart failure and preserved ejection fraction (HFpEF)
- Participants
- 281 patients
- Exposure
- T2D vs non-T2D among HFpEF patients
- T2DMn = 87
- Outcome
- Diabetes-related differences in body composition and prognostic value (subgroups by diabetes)
Methodological detailscardiac MRI-based, multivariable Cox regression
- Cardiac MRI-based
- Multivariable Cox regression
Main finding
As reported in the abstract
P = 0.005
- ParaAT-VAT ratio, aHR in T2DM
- 1.069 [1.022, 1.117]
- ParaAT-muscle ratio, aHR in T2DM
- 1.948 [1.391, 2.729]
- ParaAT-VAT ratio, aHR in non-T2DM
- 1.053 [1.006-1.103]
- ParaAT-muscle ratio, aHR in non-T2DM
- 1.597 [1.018, 2.505]
- Skeletal muscle index (SMI), aHR in non-T2DM (p < 0.001)
- 0.968 [0.951, 0.985]
- SMI, aHR in T2DM (p = 0.380)
- 0.990 [0.968, 1.012]
Observational data: associations, not effects.
Further findings
Age · older with T2DM
P < 0.001
LV volumes
- LVEDV index and LVSV index significantly lower in T2DM
Prognosis in overall HFpEF population
- Higher SMI: linear decrease of prognostic risk
- Higher ParaAT-VAT and ParaAT-muscle ratios: linearly increasing risk of poor outcomes
- Body mass index (BMI) non-linear correlation with survival risk (p for nonlinearity: 0.031); lowest vs middle tertile increased risk
Original publication
Diabetes-related differences in body composition and their prognostic value among patients with heart failure and preserved ejection fraction: a cardiac-MRI-based study. Cardiovasc Diabetol. Published 9 April 2026. doi:10.
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