Diastolic Cardiac Function Improvement by Liraglutide Is Mainly Body Weight Reduction Dependent but Independently Contributes to B-Type Natriuretic Peptide Reduction in Patients with Type 2 Diabetes with Preserved Ejection Fraction

Abstract

Objectives. A single-arm prospective study was conducted among Japanese patients with type 2 diabetes having preserved ejection fraction. The aim was to investigate (1) whether liraglutide therapy could improve B-type natriuretic peptide (BNP) levels and diastolic cardiac function assessed by the E -wave to E ′ ratio ( E / E ′ ) using transthoracic echocardiography (TTE), and (2) whether E / E ′ contributed to BNP improvement independent of bodyweight reduction (UMIN000005565). Methods. Patients with type 2 diabetes and left ventricular ejection fraction LVEF ≥ 40 % without heart failure symptoms were enrolled, and daily injection with liraglutide (0.9 mg) was introduced. Cardiac functions were assessed by TTE before and after 26 weeks of liraglutide treatment. Diastolic cardiac function was defined as septal E / E ′ ≥ 13.0 . Results. Thirty-one patients were analyzed. BNP and E / E ′ improved, with BNP levels declining from 36.8 ± 30.5 pg / mL to 26.3 ± 25.9 pg / mL ( p = 0.0014 ) and E / E ′ dropping from 12.7 ± 4.7 to 11.0 ± 3.3 ( p = 0.0376 ). The LVEF showed no significant changes. E / E ′ improved only in patients with E / E ′ ≥ 13.0 . Favorable changes in E / E ′ were canceled when adjusted for body mass index (BMI). Multivariate linear regression analysis revealed that the left ventricular diastolic diameter and ∆ E / E ′ /∆BMI contributed to ∆BNP/baseline BNP ( p = 0.0075 , R 2 = 0.49264 ). Conclusions. Liraglutide had favorable effects on BNP and E / E ′ but not on LVEF. E / E ′ improvement was only seen in patients with diastolic cardiac function. Body weight reduction affected the change of E / E ′ . The BMI-adjusted E / E ′ significantly contributed to the relative change of BNP. GLP-1 analog treatment could be considered a therapeutic option against diabetic diastolic cardiac dysfunction regardless of body weight. This trial is registered with the University Hospital Medical Information Network in Japan, with clinical trial registration number: UMIN000005565.

Effects of GLP-1 receptor agonists and SGLT-2 inhibitors on cardiac structure and function: a narrative review of clinical evidence

“…A synthesis of the available studies is provided in Table 1 . In both a single-arm [ 24 ] and a small placebo-controlled RCT [ 25 ], chronic treatment with liraglutide in T2D subjects without established cardiovascular disease (CVD) improved diastolic function by reducing filling pressures by 20% (reduced E-wave and E/e′ ratio). This effect is possibly related to the reduction in BMI.…”

Improvement of Left Ventricular Global Longitudinal Strain after 6-Month Therapy with GLP-1RAs Semaglutide and Dulaglutide in Type 2 Diabetes Mellitus: A Pilot Study

“…However, as expected, the literature presents incongruent data on the topic. Bizino et al pointed out, with the employment of cardiac magnetic resonance (CMR) in DM2 patients treated with liraglutide, a reduction in the LV filling pressure with a non-significant reduction in the systolic function after 26 weeks of treatment [ 56 ], and the same results were obtained by Yari et al [ 57 ] The meta-analysis by Zhang et al in a larger sample of 4790 subjects, highlights an increase in LVEF and a reduction in LVESV and E/e’ with GLP1-RAs compared to the placebo [ 20 ]. In the present study.…”

Comparative evaluation new glucagon-like peptide 1 receptor agonist semaglutide and sodium-glucose cotransporter-2 inhibitors empagliflozin on left ventricular diastolic function in patients with arterial hypertension, obesity and type 2 diabetes mellitus

“…Ранее рядом исследователей было показано положительное влияние аГГП-1 на ДФ ЛЖ. Так введение лираглутида оказывало благоприятное влияние на BNP и ДФ ЛЖ, но не ФВ ЛЖ, в клиническом исследовании с небольшой выборкой у пациентов с СД 2 типа и СНсФВ [40]. Оценка регрессии диастолической дисфункции с помощью МРТ сердца в исследовании MAGNA VICTORIA представляла собой одноцентровое исследование с участием 49 пациентов с СД 2 типа без ССЗ, рандомизированных для лечения лираглутидом (1,8 мг один раз в день) или плацебо.…”