SGLT2 Inhibitor use Pre-Discharge Improves Left Atrial Reservoir and Contractile Function Following Acute Coronary Syndrome in Patients With Siabetes

Abstract

Left atrial (LA) strain, a novel marker of LA function, reliably predicts diastolic dysfunction and outperforms conventional parameters. SGLT2 inhibitors can improve diastolic function in patients with type 2 diabetes (T2D) but limited data exists regarding their use in the immediate aftermath of acute coronary syndrome (ACS). We studied the effect of empagliflozin on LA strain in patients with T2D and ACS. We identified patients with ACS and T2D during hospitalisation; empagliflozin was initiated in eligible patients pre-discharge; patients not initiated on empagliflozin were the comparator group. Baseline and 3-6 month follow-up 2-dimensional echocardiograms were performed to assess LA strain. A total of 44 patients were recruited (n=22, each group). Baseline characteristics were similar (age 60.8±9.5 vs 65.1±10.4 yrs), LA volume index 32.2±9.4mL/m2 vs 35.2±11.6mL/m2, LVEF 51.1±11.3% vs 54.9±10.8%; p=NS for all. Except, HbA1c was higher in empagliflozin group (9.8±1.6% vs 6.6±0.7%, p<0.001). No difference was seen in baseline LA strain parameters between groups (reservoir 29.5% vs 30.5%, conduit 15.0% vs 12.8%, contractile 14.5% vs 17.7%; p=NS for all). LA reservoir and contractile strain increased significantly at follow-up in empagliflozin group (29.5% to 36.6%, p=0.005 and 14.5% to 17.7%, p=0.024, respectively) but remained unchanged in comparison group (30.5% to 30.5% and 17.7% to 17.0%; p=NS for both). The difference in change between groups was significant for LA reservoir and contractile strain (p=0.015 and p=0.029, respectively). LA reservoir and contractile function improve with SGLT2 inhibitor use following ACS in patients with T2DM. Larger studies are warranted to determine clinical implications.