达格列净增强左心室功能不全患者的收缩和舒张功能与临床反应一致。

IF 3.3 4区医学 Q1 Medicine

European review for medical and pharmacological sciences Pub Date : 2025-05-01 DOI:10.26355/eurrev_202505_37222

A E Abou Warda, J D Duarte, M Nabil Salem, H F Salem, A N Moharram, A S Alanazi, A I Alzarea, T G Alsahli, H Sultan, M A Alrashdi, A F Altebainawi, B Emil Ibrahim, S Ibrahim Alnahrawi, K Kamel Megalaa, B Zarif, R M Sarhan

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引用次数: 0

摘要

目的：钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂重塑心力衰竭（HF）的管理。然而，关于它们对心脏结构的影响，特别是对达格列净的影响，证据仍然不一致。本研究评估达格列净对超声心动图参数的影响及其与临床反应的一致性。材料和方法：一项前瞻性、随机对照研究纳入了伴有左心室功能障碍的HF患者，分为达格列净组和dapagliflozin-naïve组。在基线和6个月时进行超声心动图和斑点跟踪应变分析。主要观察指标为左室指数质量的变化。次要结果包括左室功能、体积、尺寸、功能性二尖瓣反流、整体纵向应变（GLS）、舒张功能、右心室（RV）功能，以及使用堪萨斯城心肌病问卷（KCCQ）评分评估的临床反应。结果：在240名参与者中，160名在指南指导的药物治疗之外接受了达格列净，80名dapagliflozin-naïve。校正回归分析显示，左室质量指数（-43.51 g/m²，95% CI: -59.4 ~ -27.5, p < 0.0001）、收缩末期容积（-29.45 mL, 95% CI: -43.9 ~ -14.9, p < 0.0001）和舒张末期容积（-29.44 mL, 95% CI: -47.9 ~ -10.9, p = 0.0021）均有显著改善。改进也观察到在LV射血分数(5.15%,95%置信区间CI: 2.84 - 7.45, p < 0.0001), gl(-1.99%, 95%置信区间CI: -2.87 - -1.11, p < 0.0001), E / A比值(-0.56,95%置信区间CI: -1.01 - -0.10, p = 0.016),有效的二尖瓣口面积(EROA)(-0.18厘米²,95%置信区间CI: -0.28 - -0.081, p = 0.0006),三尖瓣环平面收缩偏差(TAPSE)(0.38厘米,95%置信区间CI: 0.15 - 0.62, p = 0.0024),和复合临床结果(HR 0.65, 95%置信区间CI: 0.43 - -0.98, p = 0.043)。LVEF、GLS、E/A比值、TAPSE、下腔静脉内径、左房面积与临床反应相关。结论：达格列净作为左心室功能不全患者的潜在治疗方法，可增强左室收缩功能和舒张功能，并具有良好的临床疗效。未来的研究需要对右心室功能进行更广泛的评估和更长的随访。图形摘要：https://www.europeanreview.org/wp/wp-content/uploads/abstract.jpg。

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Dapagliflozin enhances systolic and diastolic function in concordance with clinical response in patients with left ventricular dysfunction.

OBJECTIVE: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have reshaped heart failure (HF) management. However, evidence regarding their effects on cardiac structure, particularly for dapagliflozin, remains inconsistent. This study evaluates dapagliflozin's impact on echocardiographic parameters and its concordance with clinical response. MATERIALS AND METHODS: A prospective, randomized controlled study included HF patients with left ventricular (LV) dysfunction, divided into dapagliflozin-treated and dapagliflozin-naïve groups. Echocardiography and speckle-tracking strain analysis were conducted at baseline and six months. The primary outcome was the change in indexed LV mass. Secondary outcomes included LV function, volumes, dimensions, functional mitral regurgitation, global longitudinal strain (GLS), diastolic function, right ventricular (RV) function, and clinical response assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) score. RESULTS: Among 240 participants, 160 received dapagliflozin in addition to guideline-directed medical therapy, while 80 were dapagliflozin-naïve. Adjusted regression analysis showed significant improvements in LV mass index (-43.51 g/m², 95% CI: -59.4 to -27.5, p < 0.0001), end-systolic volume (-29.45 mL, 95% CI: -43.9 to -14.9, p < 0.0001), and end-diastolic volume (-29.44 mL, 95% CI: -47.9 to -10.9, p = 0.0021). Improvements were also observed in LV ejection fraction (5.15%, 95% CI: 2.84 to 7.45, p < 0.0001), GLS (-1.99%, 95% CI: -2.87 to -1.11, p < 0.0001), E/A ratio (-0.56, 95% CI: -1.01 to -0.10, p = 0.016), effective regurgitant orifice area (EROA) (-0.18 cm², 95% CI: -0.28 to -0.081, p = 0.0006), tricuspid annular plane systolic excursion (TAPSE) (0.38 cm, 95% CI: 0.15 to 0.62, p = 0.0024), and composite clinical outcome (HR 0.65, 95% CI: 0.43-0.98, p = 0.043). LVEF, GLS, E/A ratio, TAPSE, inferior vena cava diameter, and left atrial area correlated with clinical response. CONCLUSIONS: Dapagliflozin emerges as a potential therapy for patients with left ventricular dysfunction, enhancing LV systolic function and diastolic performance, alongside a favorable clinical response. Future studies with more extensive assessment of right ventricular function and longer follow-up are warranted.

Graphical abstract: https://www.europeanreview.org/wp/wp-content/uploads/abstract.jpg.

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来源期刊

European review for medical and pharmacological sciences 医学-药学

CiteScore

5.30

自引率

6.10%

发文量

906

审稿时长

2-4 weeks

期刊介绍： European Review for Medical and Pharmacological Sciences, a fortnightly journal, acts as an information exchange tool on several aspects of medical and pharmacological sciences. It publishes reviews, original articles, and results from original research. The purposes of the Journal are to encourage interdisciplinary discussions and to contribute to the advancement of medicine. European Review for Medical and Pharmacological Sciences includes: -Editorials- Reviews- Original articles- Trials- Brief communications- Case reports (only if of particular interest and accompanied by a short review)