Abstract
BackgroundLiraglutide is an antidiabetic agent with cardioprotective effect. The purpose of this study is to test efficacy of liraglutide to improve diabetic cardiomyopathy in patients with diabetes mellitus type 2 (DM2) without cardiovascular disease.MethodsPatients with DM2 were randomly assigned to receive liraglutide 1.8 mg/day or placebo in this double-blind trial of 26 weeks. Primary outcome measures were LV diastolic function (early (E) and late (A) transmitral peak flow rate, E/A ratio, early deceleration peak (Edec), early peak mitral annular septal tissue velocity (Ea) and estimated LV filling pressure (E/Ea), and systolic function (stroke volume, ejection fraction, cardiac output, cardiac index and peak ejection rate) assessed with CMR. Intention-to-treat analysis of between-group differences was performed using ANCOVA. Mean estimated treatment differences (95% confidence intervals) are reported.Results23 patients were randomized to liraglutide and 26 to placebo. As compared with placebo, liraglutide significantly reduced E (− 56 mL/s (− 91 to − 21)), E/A ratio (− 0.17 (− 0.27 to − 0.06)), Edec (− 0.9 mL/s2 * 10−3 (− 1.3 to − 0.2)) and E/Ea (− 1.8 (− 3.0 to − 0.6)), without affecting A (3 mL/s (− 35 to 41)) and Ea (0.4 cm/s (− 0.9 to 1.4)). Liraglutide reduced stroke volume (− 9 mL (− 16 to − 2)) and ejection fraction (− 3% (− 6 to − 0.1)), but did not change cardiac output (− 0.4 L/min (− 0.9 to 0.2)), cardiac index (− 0.1 L/min/m2 (− 0.4 to 0.1)) and peak ejection rate (− 46 mL/s (− 95 to 3)).ConclusionsLiraglutide reduced early LV diastolic filling and LV filling pressure, thereby unloading the left ventricle. LV systolic function reduced and remained within normal range. Future studies are needed to investigate if liraglutide-induced left ventricular unloading slows progression of diabetic cardiomyopathy into symptomatic stages.Trial registration ClinicalTrials.gov: NCT01761318.
Highlights
Patients with type 2 diabetes mellitus (DM2) are at increased risk for heart failure, even in the absence of coronary artery disease and hypertension
Some studies have investigated the effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) on ischemic heart disease and symptomatic heart failure with reduced ejection fraction (HFrEF) [7], little is known about the effect on left ventricular (LV) diastolic function
Taking into consideration that the study population in our trial would have a significantly better systolic function than the patients with heart failure studied in the trial mentioned above, differences might be smaller
Summary
Patients with type 2 diabetes mellitus (DM2) are at increased risk for heart failure, even in the absence of coronary artery disease and hypertension. This so-called diabetic cardiomyopathy is characterized by left ventricular (LV) diastolic dysfunction [1] and has an estimated. The anti-diabetic agent liraglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) that improves insulin secretion, suppresses glucagon production and induces weight loss. GLP-1RA induced weight loss by itself might improve LV diastolic function [8]. The purpose of this study is to test efficacy of liraglutide to improve diabetic cardiomyopathy in patients with diabetes mellitus type 2 (DM2) without cardiovascular disease
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