Assessment of cardiac functions using two-dimensional transthoracic and speckle tracking echocardiography after treatment with SGLT2 inhibitors in Patients with HFrEF
Authors: Setouhi Amr , Radi Ashraf , Asklany Hany Taha , Farrag Hazem M A 
Published: September 2023

Abstract

Background & objective
Recently, the antidiabetic drug sodium-glucose cotransporter type 2 inhibitor (SGLT2i) has been approved among the drugs that reduce mortality in patients with HFrEF. The impact of SGLT2i inhibitors on the left ventricle longitudinal myocardial function in heart failure (HF) patients remained vague. The effect of SGLT2i on left ventricular remodeling and function in patients with HFrEF was studied using STE and traditional echocardiography.

Objectives
Studying the effects of SGLT2i on left ventricular remodeling and function in HFrEF patients using STE and traditional echocardiography.

Methods
300 patients with HFrEF were included.Study design: This prospective observational study involves 300 patients with HFrEF-administered SGLT2i (Empagliflozin & Dapagliflozin) in addition to the classical treatment of heart failure. Then the patients were followed up 2, 4 & 6 months after treatment with laboratory investigations of HbA1C and eGFR, in addition to 2D echo & STE studies.

Results
Regarding Demographic data, the mean age was 50 ± 9.2 for males and females. The mean weight, height, and body mass index (BMI) were 85.6 ± 8.8 kg, 178.6 ± 7.2 cm, and 26.6 ± 2.9, respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 115.3 ± 5.1 and 75.4 ± 4.5, respectively. The mean heart rate was 79.9 ± 10.2. The mean respiratory rate was15 ± 2.2. Regarding functional NYHA class, 1 (0.2%), 54(12%), 392 (87.1%), and 3 (0.7%) patients were class I, II, III, and IV, respectively. The lab investigations at first presentation were: mean HbA1C was 4.2 ± 0.6, and the mean of eGFR was 66.4 ± 9.3. Concerning Echocardiography data of patients LVEF by 2D echo show significant improvement from 34.73 ± 2.9 at baseline to 34.91 ± 1.2, 35.42 ± 3.5 & 36.54 ± 3.6 at 2, 4 & 6 months (P = 0.001) also GLS A4 showed significant improvement from −15.67 ± 2.74 to −16.5 ± 3.19, −17.32 ± 3.21, −18.03 ± 3.05at 2, 4 & 6 months (P = 0.001), and from −15.66 ± 2.65 to −16.50 ± 3.31, −17.41 ± 3.23 & −17.93 ± 3.32 (P = 0.001) by GLS A2 Regarding dapagliflozin LVEF by 2D echo show significant improvement from 34.87 ± 2.86 at baseline to 34.87 ± 2.86, 35.05 ± 3.01& 37.53 ± 4.1 at 2, 4 & 6 months (P = 0.001) also GLS A2 showed significant improvement from −15.67 ± 2.74 to −16.50 ± 3.31 −17.41 ± 3.23 −17.93 ± 3.32 at 2, 4 & 6 months (P = 0.001), and from −15.54 ± 2.77 to −16.84 ± 3.49, −18.48 ± 2.23 & −19.61 ± 2.98 (P = 0.001) by GLS A4, also E/e′ significantly reduced from 11.2 ± 2.7 to 9.1 ± 2.3 cm/s after administration of empagliflozin and dapagliflozin within 6 months (P = 0.01) also LAVI (ml/m2) improved from 45.6 ± 15.3 to 37.5 ± 6.5 (P = 0.001) after 6 month The results revealed a significant increase of ejection fraction at 4 and 6 months follow-up and a significant improvement of global longitudinal strain at 2, 4 & 6 months follow-up in patients given SGLT2i.

Conclusion
SGLT2i was associated with improving LV longitudinal myocardial function, further improving LV diastolic function. SGLT2i is associated with increased EF and LV longitudinal myocardial function.

Additional Content
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