Marina Pourafkari, Kim A Connelly, Subodh Verma, C David Mazer, Hwee Teoh, Adrian Quan, Shaun G Goodman, Archana Rai, Ming Yen Ng, Djeven P Deva, Piero Triverio, Laura Jiminez-Juan, Andrew T Yan, Yin Ge
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Alteration in left atrial (LA) function due to chronic pressure or volume overload is a hallmark of heart failure.</p><p><strong>Objective: </strong>To evaluate the effect of the SGLT2 inhibitor empagliflozin on LA volume and function.</p><p><strong>Methods: </strong>90 patients with coronary artery disease and type 2 diabetes (T2DM) were randomized to empagliflozin (n = 44) or placebo (n = 46), and underwent cardiac magnetic resonance (CMR) imaging at baseline and after 6 months. The main outcome was change in LA volume; LA function, including active and passive components, was also measured by a blinded reader.</p><p><strong>Results: </strong>At baseline, there was no significant difference in LA volumes between the empagliflozin (indexed maximum LA volume 26.4 ± 8.4mL/m<sup>2</sup>, minimum LA volume 11.1 ± 5.7mL/m<sup>2</sup>) and placebo (indexed maximum LA volume 28.7 ± 8.2mL/m<sup>2</sup>, minimum LA volume 12.6 ± 5.0mL/m<sup>2</sup>) groups. After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m<sup>2</sup> (95% CI: -1.7 to 3.7 mL/m<sup>2</sup>; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m<sup>2</sup> (95% CI: -0.9 to 2.6 mL/m<sup>2</sup>; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59).</p><p><strong>Conclusion: </strong>SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. 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After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m<sup>2</sup> (95% CI: -1.7 to 3.7 mL/m<sup>2</sup>; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m<sup>2</sup> (95% CI: -0.9 to 2.6 mL/m<sup>2</sup>; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59).</p><p><strong>Conclusion: </strong>SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. 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引用次数: 0
摘要
背景：钠-葡萄糖共转运体-2（SGLT2）抑制剂已证明可减少2型糖尿病患者的心衰预后，但确切的获益机制仍不清楚。慢性压力或容量超负荷导致的左心房（LA）功能改变是心力衰竭的特征之一：方法：90 名患有冠状动脉疾病和 2 型糖尿病（T2DM）的患者被随机分配到恩格列净（44 人）或安慰剂（46 人）中，并在基线和 6 个月后接受心脏磁共振（CMR）成像。主要结果是LA容积的变化；LA功能（包括主动和被动部分）也由盲人进行测量：基线时，恩格列净组（指数化最大LA容积为26.4±8.4mL/m2，最小LA容积为11.1±5.7mL/m2）和安慰剂组（指数化最大LA容积为28.7±8.2mL/m2，最小LA容积为12.6±5.0mL/m2）的LA容积无明显差异。6个月后，LA容积的变化与调整后的差异（empagliflozin减去安慰剂）不存在差异：指数化最大 LA 容量为 0.99 mL/m2 (95% CI: -1.7 to 3.7 mL/m2; p = 0.47)，指数化最小 LA 容量为 0.87 mL/m2 (95% CI: -0.9 to 2.6 mL/m2; p = 0.32)。LA总排空分数的变化也相似，组间调整后平均差为-0.01（95% CI：-0.05至0.03，P = 0.59）：结论：在T2DM和冠心病患者中，持续6个月的恩格列净SGLT2抑制剂不会对LA容量和功能产生显著影响。(Empagliflozin对2型糖尿病患者心脏结构的影响[EMPA-HEART]；NCT02998970）。
Empagliflozin and left atrial function in patients with type 2 diabetes mellitus and coronary artery disease: insight from the EMPA-HEART CardioLink-6 randomized clinical trial.
Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated reduction in heart failure outcomes in patients with type 2 diabetes mellitus, although the exact mechanism of benefit remains unclear. Alteration in left atrial (LA) function due to chronic pressure or volume overload is a hallmark of heart failure.
Objective: To evaluate the effect of the SGLT2 inhibitor empagliflozin on LA volume and function.
Methods: 90 patients with coronary artery disease and type 2 diabetes (T2DM) were randomized to empagliflozin (n = 44) or placebo (n = 46), and underwent cardiac magnetic resonance (CMR) imaging at baseline and after 6 months. The main outcome was change in LA volume; LA function, including active and passive components, was also measured by a blinded reader.
Results: At baseline, there was no significant difference in LA volumes between the empagliflozin (indexed maximum LA volume 26.4 ± 8.4mL/m2, minimum LA volume 11.1 ± 5.7mL/m2) and placebo (indexed maximum LA volume 28.7 ± 8.2mL/m2, minimum LA volume 12.6 ± 5.0mL/m2) groups. After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m2 (95% CI: -1.7 to 3.7 mL/m2; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m2 (95% CI: -0.9 to 2.6 mL/m2; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59).
Conclusion: SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes [EMPA-HEART]; NCT02998970).
期刊介绍：
Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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