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Empagliflozin and left ventricular diastolic function following an acute coronary syndrome in patients with type 2 diabetes

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Abstract

Sodium-glucose cotransporter 2 inhibitors can improve heart failure outcomes, however, the effects on left ventricular (LV) function remain unclear. This prospective observational study aimed to investigate whether initiating empagliflozin therapy was associated with improved LV diastolic function following an acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D). Patients with ACS and T2D were identified during hospitalisation in a cardiology unit. Empagliflozin was initiated at discharge in eligible patients (i.e. HbA1c > 7%) without contraindications or precautions. Transthoracic echocardiography was performed during admission and after 3–6 months. Changes in echocardiographic parameters were compared between patients initiated on empagliflozin versus not initiated on empagliflozin (control). There were 22 patients in each group (n = 44). Baseline characteristics, medications and echocardiographic parameters were similar except HbA1c (empagliflozin: 9.8 ± 1.6% versus control: 6.6 ± 0.7%, p < 0.001). Baseline LV global longitudinal strain (GLS) (empagliflozin: − 12.4 ± 2.8 versus control: − 13.0 ± 3.6%) and ejection fraction (51.1 ± 11.3 versus 54.9 ± 10.8%) were similar. The difference in change from baseline to follow-up was significant for LV mass index (empagliflozin: − 14.1 ± 21.6 versus control: 3.6 ± 18.7 g/m2, p = 0.006), left atrial volume index (− 2.1 ± 8.1 versus 3.4 ± 9.5 ml/m2, p = 0.045), mitral valve E-wave velocity (− 0.14 ± 0.23 versus 0.03 ± 0.16 m/s, p = 0.007) and average E/e′ (− 2.1 ± 2.6 versus 0.9 ± 3.4, p = 0.002). There were no significant between-group differences in change for LV GLS, ejection fraction and volume. In patients with ACS and T2D, addition of empagliflozin to ACS therapy at discharge was associated with a reduction in LV mass and favourable changes in diastolic function parameters. Further studies are warranted to investigate these findings.

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Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

SGLT2:

Sodium-glucose cotransporter 2

HF:

Heart failure

T2D:

Type 2 diabetes

CV:

Cardiovascular

HFrEF:

Heart failure with reduced ejection fraction

LV:

Left ventricular

HFpEF:

Heart failure with preserved ejection fraction

ACS:

Acute coronary syndrome

eGFR:

Estimated glomerular filtration rate

GLS:

Global longitudinal strain

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Funding

NSRL was supported by a WA Health Research Fellowship.

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Authors and Affiliations

  1. Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Perth, WA, 6150, Australia

    Nick S. R. Lan, Gillian Green, James M. Rankin & Girish Dwivedi

  2. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia

    Nick S. R. Lan, Bu B. Yeap & P. Gerry Fegan

  3. Medical School, The University of Western Australia, Perth, Australia

    Bu B. Yeap & Girish Dwivedi

  4. Medical School, Curtin University, Perth, Australia

    P. Gerry Fegan

  5. Harry Perkins Institute of Medical Research, Perth, Australia

    Girish Dwivedi

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  1. Nick S. R. Lan
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  2. Bu B. Yeap
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  4. Gillian Green
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Correspondence to Nick S. R. Lan.

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Conflicts of interest

NSRL has received research funding and speaker honoraria from Sanofi as part of a Clinical Fellowship and conference support from Boehringer Ingelheim. BBY has received speaker honoraria and conference support from Sanofi, MSD, Boehringer Ingelheim, Lilly, AstraZeneca, Novo Nordisk and Takeda, and has participated on advisory committees for Sanofi, Lilly and Novartis. PGF has received speaker honoraria and conference support from Sanofi, MSD, Boehringer Ingelheim, Lilly, AstraZeneca and Novo Nordisk. GD reports 3 paid lectures from AstraZeneca, Pfizer, and Amgen not related to the topic in the manuscript. GD provides consultancy services to Artrya Pty Ltd. There was no pharmaceutical company involvement in the planning, conduct or publication of this research. No conflicts of interest to declare for other authors.

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Ethical approval was obtained from the Human Research Ethics Committee (RGS-3023). Participants provided written informed consent and the study was conducted according to the principles of the Declaration of Helsinki.

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Lan, N.S.R., Yeap, B.B., Fegan, P.G. et al. Empagliflozin and left ventricular diastolic function following an acute coronary syndrome in patients with type 2 diabetes. Int J Cardiovasc Imaging 37, 517–527 (2021). https://doi.org/10.1007/s10554-020-02034-w

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