The effect of SGLT-2 inhibitor use on left ventricular longitudinal strain and NT-proBNP level during six-month follow-up in diabetic patients with and without coronary artery disease with preserved ejection fraction

Abstract

Background: Optimal glycemic control is necessary in order to prevent cardiovascular events to a large extent in patients with type 2 diabetes. The positive effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiovascular events and mortality in these patients have been demonstrated in previous studies, although their mechanisms are not clear. Aims: We aimed to compare the effect of SGLT2i on left ventricular remodeling and strain in diabetic patients with coronary artery disease (CAD) and without CAD during 6-month followup. Methods: Between October 2021 and June 2022, 100 diabetic patients with preserved ejection fraction (HbA1c levels 6.5–10) were started on SGLT2i (empagliflozin or dapagliflozin) and were prospectively followed-up. Conventional and speckle tracking echocardiography were performed by blinded sonographers, at baseline and 1-month, 6-month of treatment. The initial and sixth month biochemical blood tests and N-terminal pro-B-type natriuretic peptide levels of the patients were drawn. Results: Patients with CAD were older (P = 0.008), more frequently hypertensive (P = 0.035) and had dyslipidemia (P = 0.021). N-terminal pro-B-type natriuretic peptide levels did not change significantly after treatment for both groups. Left ventricular ejection fraction, global, 2-chamber and 3-chamber strain values were improved significantly following SGLTi administration for overall patient cohort, regardless of CAD status (P <0.05 for all groups). Conclusions: Treatment with SGLT2i resulted in improvement in left ventricular strain parameters indicating that they might have a positive effect on outcomes of diabetic patients with preserved EF.