The Effect of Dapagliflozin Treatment on Epicardial Adipose Tissue Volume and P-Wave Indices: An Ad-hoc Analysis of The Previous Randomized Clinical Trial

Abstract

Aim: Epicardial adipose tissue (EAT) may be associated with arrhythmogenesis. P-wave indices such as P-wave dispersion and P-wave variation indicated a slowed conduction velocity within the atria. This study investigated the effect of dapagliflozin on EAT volume and P-wave indices.Methods: In the present ad hoc analysis, 35 patients with type 2 diabetes mellitus and coronary artery disease were classified into dapagliflozin group (n 18) and conventional treatment group (n 17). At baseline, EAT volume, HbA1c and plasma level of tumor necrotic factor-(TNF-) levels, echocardiography, and 12-lead electrocardiogram (ECG) were performed. EAT volume was measured using computed tomography. Using 12-lead ECG, P-wave indices were measured. dapagliflozin group only (-9.2 8.7 vs. 5.9 19.9 ms, p 0.01; -3.5 3.5 vs. 1.7 5.9 ms, p 0.01). The change in P-wave dispersion correlated with changes in EAT volume and plasma level of TNF-. In multivariate analysis, the change in EAT volume was an independent determinant of the change in P-wave dispersion. Conclusion: Dapagliflozin reduced plasma level of TNF-, EAT volume, and P-wave indices, such as P-wave dispersion. The changes in P-wave indices were especially associated with changes in EAT volume. The number and date of registration: UMIN000035660, 24/Jan/2019 Results: At baseline, EAT volumes in the dapagliflozin and conventional treatment groups were 113 20 and 110 27 cm 3 , respectively. Not only HbA1c and plasma level of TNF-but also echocardiography findings including left atrial dimension and P-wave indices were comparable between the two groups. After 6 months, plasma level of TNFas well as EAT volume significantly decreased in the dapagliflozin group only. P-wave dispersion and P-wave variation significantly decreased in the

Effect of SGLT2-Inhibitors on Epicardial Adipose Tissue: A Meta-Analysis

“…In Gaborit et al 2021, empagliflozin treatment did not reduce EAT, despite the reduction in BMI, Hba1c, and VAT. One possible mechanism when we compared Sato T et al 2020 [17] and Sato T et al 2018 [16] was the difference in body compositions between Asians and Europeans. Sato T et al used CT imaging, and the follow-up occurred after 24 weeks, while Gaborit et al 2021 used novel multiple cardiac imaging modalities combining 1H-MRS and 31P-MRS, and the follow-up occurred after 12 weeks [18].…”

“…Previously published studies have evaluated the association between SGLT2-i and EAT changes in T2D patients, although the results were conflicting [16][17][18][19][20][21][22][23]. To date, there are no published meta-analyses that have evaluated this topic.…”

Role of Epicardial Adipose Tissue in Cardiovascular Diseases: A Review

“…These effects may contribute to the reduced the risk of MI and stroke in patients treated with thiazolidinediones [207,208]. SGLT2 inhibitors were shown to reduce EATV assessed by CMR, among patients with type 2 diabetes, both with and without obesity [209][210][211]. SGLT2 inhibitors also improved the inflammatory status of EAT [209].…”

The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

“…The main mechanisms of their cardioprotective effects are improvements in cardiac cell metabolism and ventricular loading conditions, inhibition of Na + /H + exchange in myocardial cells, alterations in adipokine and cytokine production, and reductions in cardiac cell necrosis and cardiac brosis. [34,35] SGLT2i has also been shown to reduce sympathetic overdrive, which plays an important role in the development of AF. [18] Other diabetes medications including metformin, thiazolidinedione (TZD), and DPP4i, may also be associated with a lower risk of AF.…”