Baseline neutrophil‐to‐lymphocyte ratio and efficacy of SGLT2 inhibition with empagliflozin on cardiac remodelling

Abstract

Aims The neutrophil‐to‐lymphocyte ratio (NLR) is a marker of systemic inflammation and plays a critical role in the assessment and prognosis in patients with heart failure. The EMPA‐HEART CardioLink‐6 trial demonstrated that patients with type 2 diabetes (T2D) and coronary artery disease (CAD) treated with a sodium–glucose transport protein 2 inhibitor for 6 months experienced regression in left ventricular mass. Given this, we evaluated the relationship of baseline NLR and cardiac reverse remodelling in the entire cohort of this trial. Methods and results A total of 97 individuals were randomized to receive empagliflozin (10 mg/day) or placebo for 6 months. The primary outcome of the trial was change in left ventricular mass indexed to body surface area (LVMi) from baseline to 6 months as measured by cardiac magnetic resonance imaging. In our analysis, the cohort was stratified above and below an NLR level of 2. To assess the treatment effect on the 6 month change in NLR, we used a linear model adjusting for baseline differences in NLR [analysis of covariance (ANCOVA)] that included an interaction term between the baseline NLR and treatment. To assess the treatment effect on the 6 month change in LVMi in each of the subgroups divided by baseline NLR, we used an ANCOVA adjusting for baseline differences in LVMi that included an interaction term between the subgroups and treatment. The results of the regression models were summarized as adjusted differences with two‐sided 95% confidence intervals (CIs). Patients who exhibited an elevated baseline NLR demonstrated higher LVMi and left ventricular end‐diastolic volume indexed to body surface area than those with a lower NLR. In patients with an NLR < 2 and NLR ≥ 2, the adjusted difference in LVMi between the empagliflozin‐ and placebo‐treated patients was −2.98 g/m2 (95% CI: −6.18 to 0.22 g/m2) (P value = 0.067) and −4.43 g/m2 (95% CI: −8.50 to −1.11 g/m2), respectively (Pinteraction = 0.60). Conclusions Empagliflozin treatment is associated with consistent reductions in LVMi in patients with T2D and CAD independent of baseline NLR.

Dapagliflozin, Inflammation and Left Ventricular Remodelling in Patients with Type 2 Diabetes and Left Ventricular Hypertrophy

“…In post hoc analysis of the EMPA-HEART CardioLink-6 trial that included a total of 97 patients with T2D and coronary artery disease (CAD), the effect of empagli ozin on LV mass was strati ed by NLR of > 2.1 to evaluate the correlation between baseline NLR and cardiac remodelling. The authors found that the reduction in LV mass caused by empagli ozin was independent of baseline NLR (22), which is consistent with our nding showed that the reduction in LV mass caused by dapagli ozin was not signi cantly different in patients with T2D and stage B HF, regardless of baseline level of CRP or other in ammatory cytokines. Our study included individuals without CAD and investigated more in ammatory markers CRP, and cytokines, in addition to NLR.…”