Impact of SGLT2 inhibitors on the evolution of echocardiographic parameters of patients with chronic heart failure

Abstract

Inhibitors of sodium-glucose cotransporter 2 (SGLT2) have shown, in several prospective studies, their cardiovascular benefit with more particularly a rapid and very significant decrease in hospitalizations for heart failure. The precise mechanisms accounting for the improvement of myocardial function under SGLT2 inhibitors are not yet clarified. The objective of this work is to evaluate the effect of the introduction of SGLT2, in patients with heart failure under optimal treatment, on echocardiographic parameters of left ventricular function. Descriptive analytical study conducted in 40 patients with chronic heart failure with reduced LVEF already receiving optimal treatment, based on angiotensine converting enzyme (ACE), beta-blockers and anti-aldosterone, in which we introduced dapagliflozin at 5–10 mg/day. An echocardiographic evaluation of systolodiastolic left ventricular function and longitudinal function by calculating the GLS was performed before and 3 months after initiation of treatment. Of the 40 patients, 28 of them had type 2 diabetes. On average, 82% of patients had high left ventricular systolic pressure, The mean left ventricular ejection fraction was 40 ± 3.6 before and 41.5 ± 2.5 after treatment, (P = 0.2). Analysis of diastolic function shows an E/E’ ratio at 14.2 ± 3.0 before and 08.1 ± 2.5 after treatment, (P = 0.0001), The index at 0.54 ± 0.03 before and 0.47 ± 0.02 after treatment (P = 0.004), systolic pulmonary blood pressures were 45 ± 5 mmHg before and 34 ± 3 after treatment (P < 0.000), the average GLS was −11.5 ± 2.6 before and −14.5 ± 2.7 after treatment (P < 0.000). SGLT2 inhibitors are agents with pleiotropic effects that, in addition to reducing blood sugar, provide cardiovascular benefits, by lowering preload and postloading. Cardiac fibrosis is recognized as an important pathophysiological factor in the development of heart failure. Several studies indicate an antifibrotic effect of SGLT2 inhibitors. Our modest work confirmed the positive impact of SGLT2 on the improvement of left ventricular function parameters and therefore prognosis.