Impact of diabetes duration on left ventricular mass regression with empagliflozin.

Abstract

The duration of type 2 diabetes mellitus (T2DM) is an important determinant of diabetes severity. The EMPA-HEART CardioLink-6 trial reported significant left ventricular (LV) mass indexed to body surface area (LVMi) regression in patients treated with the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin for 6months. This exploratory sub-analysis of the same trial investigated the association between T2DM duration and LVMi regression. A total of 97 individuals with T2DM and coronary artery disease (CAD) were randomly assigned to receive empagliflozin 10mg daily or placebo. LVMi was measured at the baseline and 6month visit using cardiac magnetic resonance imaging. The study population was divided into those with a baseline T2DM duration <10years (n=40) or ≥10years (n=57). A linear model adjusting for baseline values in each of the subgroups (ANCOVA) was used to assess the treatment effect of 6month change in LVMi, LV end systolic volume indexed to body surface area, LV end diastolic volume indexed to body surface area and LV ejection fraction. Patients in the T2DM duration <10years group (38 males [95.0%], median age 63 [IQR: 55years to 70years]) had a median T2DM duration of 4years (IQR: 2.0years to 7.0years). Those in the T2DM duration ≥10years group (52 males [91.2%], median age 65 [IQR: 57years to 71years]) had a median duration of 15years (IQR: 12years to 20years). There was no significant difference in baseline LVMi according to T2DM duration (median 62g/m2 [IQR: 53.1g/m2 to 70.0g/m2 ] for T2DM duration <10years; median 57.5g/m2 [IQR: 52.1g/m2 to 66.2g/m2 ] for T2DM duration ≥10years; P=0.11). Empagliflozin was associated with reductions in LVMi irrespective of duration of T2DM above and below 10years (T2DM duration <10years group, mean adjusted difference -2.90g/m2 [95% CI: -6.64g/m2 to 0.84g/m2 ]; T2DM duration ≥10years group, mean adjusted difference -3.69g/m2 [95% CI: -0.14g/m2 to -7.24g/m2 ]; Pinteraction =0.07). In the EMPA-HEART CardioLink-6 trial, empagliflozin treatment was associated with reductions in LVMi in people with T2DM and CAD irrespective of the duration of diabetes assessed categorically above and below 10years.