Review for 10.1186/s12876-023-02948-4 (2023)

Title: Effect of Empagliflozin and Pioglitazone on Left Ventricular Function in Patients with
Type Two Diabetes and Nonalcoholic Fatty Liver Disease without Established Cardiovascular
Disease: A Randomized Single-blind Clinical Trial
Version: 5 Date: 26 Jul 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors responded on some suggestions, but not fully and not
adequately. I suggested major and detailed revision. The authors provided only a few sentences
of changes. In my opinion, this is not enough for publication. In order to reconsider your article
for publication you should provide detailed revision and explanation.
REQUESTED REVISIONS:
1. The article is still written in non-cardiological manner even though the main endpoint is
GLS, which is very cardiological end-point. I have already asked authors to revise that, but they
unfortunately did not perform detailed revision and gave the article to cardiologists.
2. What does it mean standardized antidiabetic therapy? Which medications were used? It is not
enough to write that standardised therapy was used. You need to elaborate this.
3. All responses are provided as: page X, paragraph Y, line Z. It is very difficult and time-
consuming to search through the article. Moreover, your changes are minimal and they should
be extensive. Please provide your full responses on all suggestions.
4. Regarding GLS threshold guidelines, there are 3 possible cut-offs used: -16%, -18% and -20%.
The guidelines that you mentioned in the article clearly stated -20%, even though this is very
high and almost supernormal GLS. Moreover, there is standardisation for GLS for all vendors
and there is no difference in cut-off values for different vendors. Please change this in the article
and change results where necessary.
5. The description of echocardiographic examination should be revised and mostly rewritten.
6. The description of GLS evaluation is still not clear.
7. Please provide LAVI. If you have LAA, you must also have LAVI. Your echocardiographic
vendor provides both information simultaneously.
8. People with DM are patients and “people” is not a medical term for the scientific article.
Please correct this in the whole article.
9. The number of patients is very limited and any meaningful conclusion unfortunately cannot
be made from this study. It can serve only as a start point – hypothesis for the future studies and
this should be acknowledged in the discussion, limitation, as well as in the conclusion.
10. How was conclusion changed? Still very uninformative and extremely short.