Abstract
BackgroundSodium-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.MethodsBetween 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.ResultsAmong 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 − 0.85 ± 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.ConclusionsAmong 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.
Highlights
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower cardiovascular events in type 2 diabetes mel‐ litus (T2DM) patients, the mechanisms underlying these benefits are not clearly understood
The main findings of this study were that the addition of SGLT2 inhibitors to standard anti-hyperglycaemic treatment in people with T2DM was associated with: (1) a significant decrease in indexed left ventricular mass (LVM); (2) an improvement in left ventricular Global Longitudinal Strain (GLS) assessed by speckle tracking echocardiography
SGLT2 inhibitors have demonstrated a reduction in heart failure outcomes [3,4,5,6], even in non-diabetic patients [22] mechanisms to explain the cardiovascular benefits of these drugs are not clearly understood
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower cardiovascular events in type 2 diabetes mel‐ litus (T2DM) patients, the mechanisms underlying these benefits are not clearly understood. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a recent and fast growing class of oral anti-hyperglycaemic agents available to treat patients with type 2 diabetes (T2DM) [1] They function through a novel mechanism by reducing renal tubular glucose reabsorption, and produce a reduction in blood glucose without stimulating insulin release. Reverse ventricular remodelling refers to a “more-normal” chamber geometry restoration [9] Several pharmacological treatments such as angiotensin-converting enzyme (ACE) inhibitors [10], beta-blockers [11, 12] and mineralcorticoid receptor antagonists [13], have been shown to promote reverse ventricular remodelling, with reductions in left ventricular mass (LVM) and volume and improved left ventricular systolic function. Some authors advocate that reverse remodelling can serve as a valid surrogate endpoint for clinical outcomes in studies of new therapies [14]
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