Improvement of global longitudinal strain and myocardial work in type 2 diabetes patients on sodium-glucose cotransporter 2 inhibitors therapy

Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) are a novel class of oral hypoglycaemic agents currently used among patients with type 2 diabetes mellitus (T2DM). The effects of SGLT2-i inhibitors on cardiac structure and function are not fully understood. The aim of the present study is to evaluate the echocardiographic changing among patients with well-controlled TDM2 treated with SGLT2-i in real-world setting. 35 well-controlled T2DM patients (65± 9 years, 43.7% male) with preserved left ventricular ejection fraction and 35 age and sex-matched controls were included. T2DM patients underwent clinical and laboratory evaluation; 12-lead surface electrocardiogram (ECG); 2-dimensional color Doppler echocardiography at enrolment, before SGLT2-i administration, and at six months follow-up after an uninterrupted 10 mg once daily of Empagliflozin (n: 21) or Dapagliflozin (n: 14). Standard echocardiographic measurements, LV global longitudinal strain (LV-GLS), global wasted work (GWW) and global work efficiency (GWE) were calculated. T2DM patients showed higher E\E’ ratio (8.3± 2.5 vs. 6.3± 0.9; p< 0.0001) and lower LV-GLS (15.8 ± 8.1 vs. 22.1± 1.4%; P<0.0001) and global myocardial work efficiency (91± 4 vs 94± 3%; P: 0.0007) compared to age and sex-matched controls. At six-months follow-up, T2DM patients showed a significant increase in LVEF (58.9± 3.2 vs 62± 3.2; p<0.0001), LV-GLS (16.2± 2.8 vs 18.7± 2.4%; p=0.003) and GWE (90.3± 3.5 vs 93.3± 3.2%; P= 0.0004) values; conversely, GWW values (161.2± 33.6 vs 112.72± 37.3 mmHg%; P<0.0001) significantly decreased. Well-controlled TDM2 patients with preserved left ventricular ejection fraction who are treated with a SGLT2-i on top of the guidelines direct medical therapy showed a favourable cardiac remodelling, characterized by the improvement of LV-GLS and MWE.

Positive Correlation between BMI and Left Ventricle and Atrium Inside Diameter Size in Chinese Type 2 Diabetes Patients with Left Ventricular and Atrial Enlargement

“…This is in accordance with the finding that the introduction of novel therapies, such as sodium-glucose co-transporter 2 (SGLT2i) improved the risk of HF in diabetic patients [ 21 ]. Moreover, SGLT2i has also been proven to ameliorate cardiac remodeling, previously characterized by the improvement of left ventricular global longitudinal strain (LV-GLS) and myocardial work efficiency in hearts with preserved ejection fraction, while BMI owns a positive correlation with left ventricular size [ 22 ], which implies that patients with higher BMIs possess bigger left ventricular volumes and HF risks [ 23 ]. Thus, BMI may be an early predictor of HF in type 2 diabetes patients.…”

Role and molecular mechanisms of SGLT2 inhibitors in pathological cardiac remodeling (Review)

“…In addition, the left ventricular (LV) mass index (LVMI) and LV ejection fraction (LVEF) are used as evaluation indexes of cardiac structural function ( 23 , 24 ). Studies have reported that SGLT2isThe improved cardiac function is mainly manifested as increased LVEF and decreased LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), left atrial volume index (LAVI) and LVMI ( 22 , 25 – 35 ). However, LV diastolic dysfunction (LVDD) often manifests as altered LV diastolic filling and is assessed based on the peak mitral E wave velocity to early mitral or septal annular tissue Doppler velocity ratio (E/e'), peak mitral E wave velocity to A wave velocity ratio and LAVI ( 36 ).…”

Advanced imaging guiding early sodium-glucose-cotransporter-2-inhibitor therapy: an outlook to the future?

“…In their interesting article, Russo et al 7 evaluated changes in these advanced echocardiographic markers of cardiac function among 35 asymptomatic patients with well-controlled DM treated with SGLT2-i with normal LV-EF and compared with an age- and sex-matched control group. By excluding patients with poorly controlled DM, established or suspected coronary artery disease, or significant chronic kidney disease, the authors weed out patients at the highest risk of coronary artery disease, making their findings particularly captivating from the perspective of early primary prevention.…”