Abstract
BackgroundThe objective of this study was to investigate the impact of sodium glucose cotransporter type 2 (SGLT2) inhibitors on left ventricular (LV) diastolic function of type 2 diabetes mellitus (T2DM) patients with heart failure (HF).MethodsThis trial was a prospective multicenter study of 58 T2DM patients with stable HF at five institutions in Japan. Patients who had been taking at least one antidiabetic drugs other than SGLT2 inhibitors started the administration of 5 mg/day of dapagliflozin. The physical examinations, blood tests, and echocardiography were performed at baseline and 6 months after administration of dapagliflozin. The primary endpoint was defined as a change in mitral inflow E and mitral e′ annular velocities (E/e′) between baseline and 6 months after the administration of dapagliflozin. The secondary end points consisted of a change in brain natriuretic peptide (BNP), LV mass index (LVMI) and left atrial volume index (LAVI).ResultsE/e′ significantly decreased from 9.3 to 8.5 cm/s (p = 0.020) 6 months after administration of dapagliflozin. LAVI and LVMI significantly decreased from 31 to 26 mL/m2 (p = 0.001), and from 75.0 to 67.0 g/m2 (p < 0.001), respectively, 6 months after administration of dapagliflozin. No significant change was observed in BNP (from 27.9 to 28.9 pg/mL; p = 0.132) 6 months after administration of dapagliflozin, except for a significant decrease from 168.8 to 114.3 pg/mL (p = 0.012) in patients with BNP ≥ 100 pg/mL.ConclusionThis prospective multicenter trial showed the beneficial effect of SGLT2 inhibitors on LV diastolic functional parameters for T2DM patients with HF. Our findings may thus offer a new insight into the management of T2DM patients.Trial registration UMIN000019789, Registered 28 September 2014, Date of registration: 11/14/2015, Date of enrolment of the first participant to the trial: 6/15/2016, Date of enrolment of the last participant to the trial: 12/9/2017
Highlights
Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF), both with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF), as well as cardiovascular disease [1, 2]
The objective of this study was, to investigate the impact of dapagliflozin on the left ventricular (LV) diastolic function of type 2 diabetes mellitus (T2DM) patients with stable HF. This trial was a prospective multicenter study to investigate the effect of sodium glucose cotransporter type 2 (SGLT2) inhibitors on LV diastolic functional parameters of T2DM patients with stable HF at five institutions in Japan
No significant change was observed in brain natriuretic peptide (BNP) 6 months after administration of dapagliflozin from 27.9 pg/mL (9.0–58.2) at baseline to 28.9 pg/mL (9.6–62.9) (p = 0.132), but BNP significantly decreased from 168.8 pg/mL (144.3–465.3) to 114.3 pg/mL (98.3– 235.3) (p = 0.012) in T2DM patients with BNP ≥ 100 pg/ mL (Fig. 3)
Summary
Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF), both with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF), as well as cardiovascular disease [1, 2]. Findings of a large clinical trial to evaluate the effects of dapagliflozin, another SGLT2 inhibitor, on cardiovascular outcomes, DECLARE TIMI-58 [8], have not been published yet. This trial is being conducted with a broad range of T2DM patients with either established cardiovascular disease or multiple cardiovascular risk factors. The objective of this study was to investigate the impact of sodium glucose cotransporter type 2 (SGLT2) inhibitors on left ventricular (LV) diastolic function of type 2 diabetes mellitus (T2DM) patients with heart failure (HF)
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