Effect of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors on Left Ventricular Remodelling and Longitudinal Strain: A Prospective Observational Study

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower cardiovascular events in type 2 diabetes mellitus (T2DM) patients, although the mechanisms underlying these benefits are not clearly understood. Our aim was to study the effects of SGLT2i on left ventricular remodelling and longitudinal strain.Methods: Between November 2019 and April 2020, we included 52 patients with T2DM ≥18 years old, with HbA1c between 6.5% and 10.0%, and estimated glomerular filtration ≥45 ml/min/1.73 m2. Patients were classified into SGLT2i group and control group, according to prescribed treatment by their referring physician. Conventional and speckle tracking echocardiography were performed by blinded sonographers, at baseline and after 6 months of treatment.Results: Among the 52 included patients (44% females, mean age 66.8±8.6 years, mean HbA1c was 7.40±0.7%), 30 patients were prescribed SGLT2i and 22 patients were classified as control group. Mean change in indexed left ventricular mass (LVM) was -10.85±3.31 g/m2 (p=0.003) in the SGLT2i group, and +2.34±4.13 g/m2 (p=0.58) in the control group. Absolute value of Global Longitudinal Strain (GLS) increased by a mean of 1.29±0.47 (p=0.011) in the SGLT2i group, and 0.40±0.62 (p=0.34) in the control group. We did not find correlations between changes in LVM and GLS, and other variables like change in HbA1c.Conclusions: Among patients with T2DM, SGLT2i were associated with a significant reduction in indexed LVM and a significant increment in longitudinal strain measured by speckle tracking echocardiography, which may explain in part the clinical benefits found in clinical trials.

Preventive Effect Observation of Dapagliflozin on Middle and Later Ventricular Remodeling in Patients with Acute ST Segment Elevation Anterior Wall Myocardial Infarction: A Single-Center, Retrospective Cohort Study

“…is study is not aimed at patients with STEMI, though Gamaza-Chulián et al [22] confirmed the protective effect of SGLT2i on ventricular remodeling through a prospective cohort study. In this study, the subjects were patients with anterior wall STEMI, which were more targeted.…”

The impact of medical therapy on left ventricular strain: Current state and future perspectives

“…78 In the clinical trial of S. Gamaza-Chulian et al in 52 patients with type 2 diabetes mellitus and without CHF a 6-month treatment with various SGLT2i was associated with a significant increase in GLS by a mean 1.29 ± 0.47 (p = 0.011) in comparison to the control group, where GLS increased by 0.40 ± 0.62 (p = 0.34). 79 Similar data were obtained in 53 diabetic patients with CHF with reduced, mildly reduced and preserved EF: the GLS significantly increased after 6 months of dapagliflozin therapy, moreover this positive effect was more pronounced in patients with preserved EF. 80 1.3 | Speckle tracking analysis utility in patients with heart failure with reduced EF treatment…”

“…The protective effect of SGLT2i on LV systolic function in non‐diabetic mice treated with doxorubicin has been demonstrated in an experimental study, where empagliflozin prevented the reduction of global radial and longitudinal strain 78 . In the clinical trial of S. Gamaza‐Chulian et al in 52 patients with type 2 diabetes mellitus and without CHF a 6‐month treatment with various SGLT2i was associated with a significant increase in GLS by a mean 1.29 ± 0.47 ( p = 0.011) in comparison to the control group, where GLS increased by 0.40 ± 0.62 ( p = 0.34) 79 . Similar data were obtained in 53 diabetic patients with CHF with reduced, mildly reduced and preserved EF: the GLS significantly increased after 6 months of dapagliflozin therapy, moreover this positive effect was more pronounced in patients with preserved EF 80 …”

Effects of 3 months of treatment with empagliflozin on left ventricle global longitudinal strain and myocardial mechano‐energetic effiency

“…In the present study, it was shown that Empagliflozin could improve global longitudinal contraction with its positive effects on the increased RAA system and impaired substrate metabolism. The study of Chulian et al., with fewer cases, supports the fact that SGLT‐2 inhibitors increase GLS 20 …”

“…The study of Chulian et al, with fewer cases, supports the fact that SGLT-2 inhibitors increase GLS. 20 Cardiac metabolism depends on aerobic oxidation. The continuous energy provided by this oxidation, creates MME activity along with left ventricular structure and function.…”