Dapagliflozin Effects on Cardiac Deformation in Heart Failure and Secondary Clinical Outcome

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-12-01 DOI:10.1016/j.jcmg.2024.05.014

Maria Concetta Pastore MD , Andrea Stefanini MD , Giulia Elena Mandoli MD , Pietro Piu PhD , Enrico Emilio Diviggiano MD , Maria Alma Iuliano MD , Leonardo Carli MD , Andrea Marchese MD , Luca Martini MD , Alessio Pecere MD , Luna Cavigli MD, PhD , Elisa Giacomin MD , Antonio Pagliaro MD , Francesca Maria Righini MD , Carlotta Sorini Dini MD , Hatem Soliman Aboumarie MD , Marta Focardi MD, PhD , Flavio D’Ascenzi MD, PhD , Serafina Valente MD , Matteo Cameli MD, PhD

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引用次数: 0

Abstract

Background

Sodium-glucose cotransporter 2 inhibitors were shown to reduce morbidity and mortality in patients with heart failure.

Objectives

This study aims to assess potential effects of dapagliflozin in nondiabetic patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF) on cardiac function assessed by speckle tracking echocardiography (STE).

Methods

This randomized, prospective, single-center, open-label trial compared consecutive nondiabetic outpatients with HFrEF or HFmrEF receiving dapagliflozin with patients treated with optimal medical therapy (OMT) except sodium-glucose cotransporter type 2 inhibitors. Primary endpoint was the presence of a significant modification of left ventricular global longitudinal strain, diastolic function (as peak atrial longitudinal strain) and right ventricular function by STE from baseline to 6 months. Cardiovascular events and parameters of congestion were assessed as safety-exploratory endpoints.

Results

Overall, 88 patients (38% HFmrEF) were enrolled and randomized to start dapagliflozin on top of OMT (n = 44) or to continue with OMT (n = 44). All STE values improved in the dapagliflozin group after 6 months, whereas there was a nonsignificant improvement in OMT group. Moreover, when comparing the modification of STE parameters at follow-up in patients with HFrEF and HFmrEF, only the main treatment effect resulted statistically significant in both groups (P < 0.0001), indicating a significant difference between dapagliflozin and OMT.

Conclusions

This study provided randomized data on the beneficial effect of dapagliflozin in nondiabetic patients with HFrEF and HFmrEF in terms of myocardial performance measured by the most sensitive echocardiographic technique, ie, STE. This suggests its usefulness for left ventricular reverse remodeling and better quality of life in patients with HFrEF and HFmrEF. (Effects of Dapagliflozin on cardiac deformation and clinical outcomes in heart failure with reduced and mildly reduced ejection fraction [DAPA ECHO trial]; EudraCT number: 2021-005394-66)

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达帕格列净对心力衰竭患者心脏变形的影响及次要临床结果

背景：钠-葡萄糖共转运体 2 抑制剂可降低心衰患者的发病率和死亡率：钠-葡萄糖共转运体2抑制剂可降低心力衰竭患者的发病率和死亡率：本研究旨在评估达帕格列净对射血分数降低型心力衰竭（HFrEF）和射血分数轻度降低型心力衰竭（HFmrEF）非糖尿病患者使用斑点追踪超声心动图（STE）评估心功能的潜在影响：这项随机、前瞻性、单中心、开放标签试验比较了连续接受达帕格列净治疗的非糖尿病门诊HFrEF或HFmrEF患者与接受最佳药物治疗（OMT）（钠-葡萄糖共转运体2型抑制剂除外）的患者。主要终点是 STE 从基线到 6 个月期间对左心室整体纵向应变、舒张功能（以心房纵向应变峰值表示）和右心室功能是否有显著改变。心血管事件和充血参数作为安全探索性终点进行评估：共有88名患者（38%为HFmrEF）入组，随机分配在OMT基础上开始达帕格列净治疗（44人）或继续OMT治疗（44人）。6个月后，达帕格列净组的所有STE值均有所改善，而OMT组的改善不明显。此外，在比较HFrEF和HFmrEF患者随访时STE参数的变化时，两组中只有主治疗效应具有统计学意义（P < 0.0001），表明达帕格列净和OMT之间存在显著差异：这项研究提供了随机数据，说明达帕格列净对非糖尿病 HFrEF 和 HFmrEF 患者的心肌表现具有有益作用，其测量方法是最敏感的超声心动图技术，即 STE。这表明，达帕利酮有助于促进 HFrEF 和 HFmrEF 患者的左心室逆向重塑并提高生活质量。(Dapagliflozin 对射血分数降低和轻度降低的心衰患者心脏变形和临床预后的影响 [DAPA ECHO 试验]；EudraCT 编号：2021-005394-66）。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.