Body composition patterns may differ in patients with heart failure with preserved ejection fraction (HFpEF) with and without diabetes, with potential implications for prognosis. This observational study, published in Cardiovascular Diabetology, evaluated 281 patients with HFpEF, including 87 with type 2 diabetes mellitus (T2DM), to assess body composition and its association with clinical outcomes.

Using cardiac magnetic resonance (CMR), regional adipose depots, including subcutaneous adipose tissue, visceral adipose tissue (VAT), and paracardial adipose tissue (ParaAT), as well as thoracic skeletal muscle, were quantified. Associations between these parameters and adverse outcomes were analyzed using multivariable Cox regression in the overall cohort and subgroups stratified by diabetes status.

Patients with HFpEF and T2DM were older and had lower left ventricular end-diastolic volume (LVEDV) and left ventricular stroke volume (LVSV) indices. The ParaAT index was higher in patients with T2DM. In the overall cohort, higher skeletal muscle index (SMI) was associated with lower prognostic risk, while higher ParaAT-VAT and ParaAT-muscle ratios were associated with increased risk of adverse outcomes. BMI showed a nonlinear association with survival risk (p for nonlinearity = 0.031).

In subgroup analyses, ParaAT-VAT and ParaAT-muscle ratios showed stronger associations with adverse outcomes in patients with T2DM (adjusted HR 1.069 and 1.948, respectively). The protective association of higher SMI was observed only in patients without T2DM. BMI-related risk patterns differed by diabetes status.

Concomitant T2DM was associated with greater paracardial adipose tissue and stronger associations between body composition measures and adverse outcomes in HFpEF.