Effect of semaglutide on global longitudinal strain and global myocardial work efficiency in patients with uncontrolled type 2 diabetes mellitus and obesity
Authors: Armentaro G , Cassano V , Crescibene D , Divino M , Barbara K , Daidone M , Condoleo V , Miceli S , Maio R , Perticone M , Tuttolomondo A , Sesti G , Sciacqua A 
Published: November 2023

Abstract

Background
Type 2 Diabetes mellitus (T2DM) increases of two-to three-fold the risk of cardiovascular disease (CVD). Cardiovascular outcome trials (CVOTs) demonstrated that glucagon-like peptide 1-receptor agonists (GLP1-RAs), as semaglutide in SUSTAIN-6 study, have effectively reduced CV risk in T2DM patients, so their use is recommended by guidelines.

Purpose
The objective of our work was to evaluate the effect of Semaglutide administration in a cohort of uncontrolled diabetic patients (within 5 years from diagnosis) on oxidative stress validated markers (8-isoprostane and NOX-2), platelet activation indicators (Sp-Selectin) and subclinical myocardial damage evaluated by measurement of deformation and efficiency parameters, obtained by speckle tracking echocardiography (STE).

Methods
We enrolled 70 Caucasian patients (mean age 65.5±8.2) with T2DM and obesity, 54 men and 16 women, 85.7% with hypertension, 14.2% with chronic obstructive pulmonary disease, 57.1% with sleep apnea syndrome, 18.5% with chronic kidney disease, and 41.4% with dyslipidemia. All patients were treated with statins and metformin, 42.8% with insulin, 24.2% with diuretics, 37.1% with ACE inhibitors, and 48.5% with angiotensin receptor antagonists. In the study the mean dose of semaglutide was 0.59±0.29 mg/week, no serious adverse events were reported.

Results
After 6 months of follow-up a significant improvement in fasting plasma glucose, insulinemia, HOMA, IGF-1, HbA1c and BMI (p&lt;0.0001) was reported. In addition, there was a significant reduction in biomarkers of oxidative stress such as 8-isoprostane, Nox-2 and uric acid (p&lt;0.0001), biomarkers of platelet activity such as Sp-Selectin and high-sensitivity C-reactive protein (hs-CRP) (p&lt;0.0001). Moreover, we observed a significant improvement in left ventricular myocardial deformation parameters such as Global longitudinal strain (GLS) (p&lt;0.0001) and global myocardial work efficiency (GWE) (p&lt;0.0001). The linear correlation analysis showed that variation (Δ) GLS was inversely correlated with ΔHOMA (p=0.011), Δuric acid (p=0.025) and ΔSp-selectin (p&lt;0.0001); ΔGWE was inversely correlated with ΔHOMA (p=0.011), Δuric acid (p=0.025) and ΔSp-selectin (p&lt;0.0001). From stepwise multivariate linear regression model, ΔSp-selectin, ΔHOMA and Δuric acid justifying 27.8%(p&lt;0.0001), 5.6%(p=0.010) and 4.4%(p=0.023) of ΔGLS variation, respectively. Instead ΔNOX-2, Δhs-CRP and ΔBMI justifying 22.3%(p&lt;0.0001), 15.6%(p&lt;0.0001), and 4.0%(p=0.022) of ΔGWE variation, respectively.

Conclusion
Treatment for 6 months with Semaglutide, in patients with uncontrolled T2DM and obesity, improved GLS and GWE. It’s plausible that this improvement may be justified by the reduction of inflammatory, oxidative stress and platelet activation parameters together with favorable metabolic changes; thus promoting coronary microcirculation protection with positive effects on myocardial contractility.