title: Relationship of Cardiac Structure and Function to Cardiorespiratory Fitness and Lean Body Mass in Adolescents and Young Adults with Type 2 Diabetes.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov:NCT00081328.
authors: Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX.
authors: Fida
authors: F
authors: Bacha
authors: Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington, DE.
authors: Samuel S
authors: SS
authors: Gidding
authors: Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, CO. Electronic address: laura.pyle@ucdenver.edu.
authors: Laura
authors: L
authors: Pyle
authors: Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Lorraine
authors: L
authors: Levitt Katz
authors: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors: Andrea
authors: A
authors: Kriska
authors: Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors: Kristen J
authors: KJ
authors: Nadeau
authors: Departments of Medicine, Radiology and Epidemiology, Johns Hopkins University, Baltimore, MD.
authors: Joao A C
authors: JAC
authors: Lima
mesh_terms: D000293:Adolescent; D001823:Body Composition; D000072599:Cardiorespiratory Fitness; D002648:Child; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D013599:Systole; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: body composition; echocardiography; fitness; left ventricular function; right ventricular function; type 2 diabetes