Impact of Empagliflozin Versus Dapagliflozin on Left Ventricular Remodeling in Heart Failure Patients: A 1-Year Comparative Study

Abstract

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce cardiovascular mortality and heart failure (HF)-related hospitalizations in HF patients. However, the mechanisms underlying these benefits remain unclear, and it is uncertain whether empagliflozin and dapagliflozin have differential effects on cardiac structure and function.

Aim

This study aims to compare the effects of these two SGLT2is on left ventricular echocardiographic parameters in HF patients over 1 year.

Methods

This retrospective study included 558 consecutive HF patients newly prescribed either dapagliflozin or empagliflozin. Key echocardiographic parameters, such as peak E-wave velocity, E/e' ratio, left atrial volume index (LAVI), LV end-diastolic and end-systolic volumes (LV-EDVI, LV-ESVI), LV mass index (LV-MI), relative wall thickness (RWT), LV sphericity index (LV-SI), and ejection fraction (LVEF), were measured at baseline and after 1 year.

Results

At 1-year, significant reductions were observed only in the empagliflozin group for peak E-wave velocity (mean difference = −12.76 cm/s, 95% CI: −16.26 to −9.27, p < 0.001), E/e' ratio (mean difference = −3.04, 95% CI: −4.17 to −1.91, p < 0.001), and LV sphericity index (LV-SI; mean difference = −0.01, 95% CI: −0.02 to −0.0005, p = 0.040). Both SGLT2is significantly improved E-wave deceleration time, LAVI, LV-EDVI, LV-ESVI, LV-MI, and LVEF. Neither medication produced significant changes in RWT, and no significant differences were noted between groups regarding HF hospitalizations or all-cause mortality.

Conclusion

Empagliflozin demonstrated more pronounced effects on LV remodeling markers, including peak E-wave velocity, E/e' ratio, and LV-SI, compared to dapagliflozin. These findings suggest potential efficacy differences between SGLT2is, highlighting the need for future randomized comparative studies.