#5825 REAL WORLD EVALUATION OF SGLT2 INHIBITORS IN PATIENTS WITH DIABETIC NEPHROPATHY AND HEART FAILURE: THE EFFECT ON THE DIASTOLIC DYSFUNCTION

Abstract

Abstract Background and Aims In patients with diabetes mellitus and diabetic nephropathy, a high incidence of left ventricular diastolic dysfunction has been reported by various studies. The objective of this study was to the real world evaluation of the impact of sodium glucose cotransporter type 2 (SGLT2) inhibitors on left ventricular (LV) diastolic function of type 2 diabetes mellitus (T2DM) patients with diabetic nephropathy and heart failure (HF). Method We studied patients with Diabetes Mellitus type 2, diabetic nephropathy (eGFR> 30 ml/min/1.73 m2) and stable (at least for 3 months) Heart Failure with reduced ejection fraction. We excluded patients treated with iSGLT2 before the study initiation. Laboratory and Echocardiographic studies (Left Ventricular Ejection Fraction LVEF%, the ratio (E/A), Early diastolic velocity (Em), LV mass index (LVMI)), were performed in all patients at baseline and after 12 months of treatment with dapagliflozin 10 mg/day. Results 67 patents were included (38/29 M/F, age 68±14.2years), with eGFR 72.5±9.2 ml/min/1.72 m2) at baseline. Mean duration of diabetes was 14.2 ± 7.9 years, and mean HbA1c was 7.9 ± 1.1%. There was a significant increase of LVEF (38.5±8.1% to 43.7±7.4%; p = 0.02). LV Mass Index was decreased from 78 g/m2 to 67 g/m2 (p = 0.01) and there was a significant decrease in E/e′ (11.8 to 9.6 cm/s (p = 0.01). Urinary albumin excretion rate at baseline was 526±233 mg/24H and there was a reduction of 32% at the end of the follow up. Multiple regression analysis showed that reduction in albuminuria was an independent predictive factor for E/e′ changes. Conclusion Data from this study showed LV diastolic function as assessed in terms of E/e′ and LVMI had significantly improved 12 months after the initiation of dapagliflozin. Reduction of albuminuria by SGLT2i, is an independent predictive factor for improvement of LV function.