Early Changes in Left Atrial Mechanics During Sodium-Glucose Cotransporter-2 Inhibitor Therapy in Heart Failure with Preserved Ejection Fraction.

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Anatolian Journal of Cardiology Pub Date : 2026-10-19 DOI:10.14744/AnatolJCardiol.2026.6899

Selen Cansu Altun, Nil Özyüncü, İrem Müge Akbulut Koyuncu, Türkan Seda Tan

{"title":"Early Changes in Left Atrial Mechanics During Sodium-Glucose Cotransporter-2 Inhibitor Therapy in Heart Failure with Preserved Ejection Fraction.","authors":"Selen Cansu Altun, Nil Özyüncü, İrem Müge Akbulut Koyuncu, Türkan Seda Tan","doi":"10.14744/AnatolJCardiol.2026.6899","DOIUrl":null,"url":null,"abstract":"Background: Conventional echocardiographic improvements after sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy have been reported in heart failure with preserved ejection fraction (HFpEF), but data on novel composite indices of atrial mechanics, particularly the left atrial (LA) stiffness index and the left atrioventricular coupling index (LACI), remain poorly characterized. The authors evaluated early changes in conventional diastolic parameters and atrial mechanics following initiation of SGLT2 inhibitor therapy.Methods: In this prospective, single-center observational cohort study, patients with HFpEF in sinus rhythm who were naive to SGLT2 inhibitors received empagliflozin or dapagliflozin. Clinical assessment, laboratory testing, and comprehensive echocardiography were performed at baseline and after 3 months. Echocardiographic evaluation included LA reservoir and pump strain, the LA stiffness index (E/e'/LA reservoir strain), and LACI (minimum LA volume/LV end-diastolic volume ×100).Results: Fifty patients completed follow-up (70% women; mean age, 63.9 ± 8.1 years). New York Health Association functional class improved and N-terminal pro-brain natriuretic peptide levels decreased significantly (347 [134.8-524.8] vs. 257 [161.3-427.5] pg/mL; P = .007). Left atrial volume index and E/e' decreased significantly (34.6 ± 5.5 to 32.6 ± 5.7 mL/m2 and 12.1 ± 3.2 to 9.8 ± 2.8, respectively; both P < .001). Left atrial reservoir and pump strain increased, whereas the LA stiffness index and LACI decreased significantly (all P < .001).Conclusions: In this prospective observational cohort of patients with HFpEF, initiation of SGLT2 inhibitor therapy was associated with early changes in conventional diastolic parameters and LA mechanics. Composite atrial indices, particularly the LA stiffness index and LACI, changed in parallel with established clinical and echocardiographic markers, suggesting that they may provide complementary information for monitoring early atrial remodeling during SGLT2 inhibitor therapy.","PeriodicalId":7835,"journal":{"name":"Anatolian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anatolian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.14744/AnatolJCardiol.2026.6899","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Conventional echocardiographic improvements after sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy have been reported in heart failure with preserved ejection fraction (HFpEF), but data on novel composite indices of atrial mechanics, particularly the left atrial (LA) stiffness index and the left atrioventricular coupling index (LACI), remain poorly characterized. The authors evaluated early changes in conventional diastolic parameters and atrial mechanics following initiation of SGLT2 inhibitor therapy.

Methods: In this prospective, single-center observational cohort study, patients with HFpEF in sinus rhythm who were naive to SGLT2 inhibitors received empagliflozin or dapagliflozin. Clinical assessment, laboratory testing, and comprehensive echocardiography were performed at baseline and after 3 months. Echocardiographic evaluation included LA reservoir and pump strain, the LA stiffness index (E/e'/LA reservoir strain), and LACI (minimum LA volume/LV end-diastolic volume ×100).

Results: Fifty patients completed follow-up (70% women; mean age, 63.9 ± 8.1 years). New York Health Association functional class improved and N-terminal pro-brain natriuretic peptide levels decreased significantly (347 [134.8-524.8] vs. 257 [161.3-427.5] pg/mL; P = .007). Left atrial volume index and E/e' decreased significantly (34.6 ± 5.5 to 32.6 ± 5.7 mL/m2 and 12.1 ± 3.2 to 9.8 ± 2.8, respectively; both P < .001). Left atrial reservoir and pump strain increased, whereas the LA stiffness index and LACI decreased significantly (all P < .001).

Conclusions: In this prospective observational cohort of patients with HFpEF, initiation of SGLT2 inhibitor therapy was associated with early changes in conventional diastolic parameters and LA mechanics. Composite atrial indices, particularly the LA stiffness index and LACI, changed in parallel with established clinical and echocardiographic markers, suggesting that they may provide complementary information for monitoring early atrial remodeling during SGLT2 inhibitor therapy.

查看原文本刊更多论文

保留射血分数的心力衰竭患者钠-葡萄糖共转运蛋白-2抑制剂治疗期间左心房力学的早期变化。

背景：在保留射血分数（HFpEF）的心力衰竭患者中，钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂治疗后，传统超声心动图的改善已被报道，但新的心房力学复合指数，特别是左心房（LA）僵硬指数和左房室耦合指数（LACI）的数据仍然缺乏特征。作者评估了SGLT2抑制剂治疗开始后常规舒张参数和心房力学的早期变化。方法：在这项前瞻性、单中心观察队列研究中，初诊SGLT2抑制剂的窦性心律HFpEF患者接受恩格列净或达格列净治疗。在基线和3个月后进行临床评估、实验室检查和综合超声心动图检查。超声心动图评价包括左室储层和泵应变、左室刚度指数（E/ E′/左室储层应变）和最小左室容积/左室舒张末期容积×100。结果：50例患者完成随访，其中70%为女性，平均年龄63.9±8.1岁。纽约健康协会功能分级改善，n -末端前脑利钠肽水平显著降低（347[134.8-524.8]对257 [161.3-427.5]pg/mL; P = .007）。左房容积指数和E/ E′明显降低（分别为34.6±5.5 ~ 32.6±5.7 mL/m2和12.1±3.2 ~ 9.8±2.8，P均< 0.001）。左心房储液池和泵应变增加，左心房僵硬指数和左心房左心室强度显著降低（P < 0.001）。结论：在HFpEF患者的前瞻性观察队列中，SGLT2抑制剂治疗的开始与常规舒张参数和LA机制的早期变化有关。复合心房指数，特别是LA僵硬指数和LACI，与既定的临床和超声心动图标志物平行变化，表明它们可能为监测SGLT2抑制剂治疗期间的早期心房重构提供补充信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Anatolian Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.30

自引率

7.70%

发文量

270

审稿时长

12 weeks

期刊介绍： The Anatolian Journal of Cardiology is an international monthly periodical on cardiology published on independent, unbiased, double-blinded and peer-review principles. The journal’s publication language is English. The Anatolian Journal of Cardiology aims to publish qualified and original clinical, experimental and basic research on cardiology at the international level. The journal’s scope also covers editorial comments, reviews of innovations in medical education and practice, case reports, original images, scientific letters, educational articles, letters to the editor, articles on publication ethics, diagnostic puzzles, and issues in social cardiology. The target readership includes academic members, specialists, residents, and general practitioners working in the fields of adult cardiology, pediatric cardiology, cardiovascular surgery and internal medicine.