Can Empagliflozin Improve Left Ventricular Strain Parameters in Patients with Type-2 Diabetes Mellitus and Normal Ejection Fraction?

Year 2022, , 390 - 399, 02.09.2022

Ferhat Işık Burhan Aslan Önder Bilge Ümit İnci Ercan Taştan Abdurrahman Akyüz Muhammed Demir Halil Akın Eşref Araç

https://doi.org/10.5798/dicletip.1169682

Abstract

Can Empagliflozin Improve Left Ventricular Strain Parameters in Patients with Type-2 Diabetes Mellitus and Normal Ejection Fraction?

Abstract

Objectives: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are known to improve symptoms and reduce mortality in patients with heart failure (HF). Empagliflozin is an SGLT-2 inhibitor. Although empagliflozin is beneficial in patients with type-2 diabetes mellitus (DM) with or without HF, data on how empagliflozin affects echocardiographic parameters are limited. We aim to evaluate the changes in left ventricular myocardial strain parameters with 2-dimensional speckle-tracking echocardiography (2D-STE) in patients with type-2 DM and normal ejection fraction (EF) after empagliflozin treatment.
Methods: A total of 92 participants were included in our study. Forty-eight of them had type-2 DM and 44 were the control group. The left ventricular ejection fraction (LVEF) of the type-2 DM patients was normal, and there were no HF symptoms and findings. Empagliflozin 10 mg once daily was given to the diabetic group. Initial and at the end of the 3rd month, the 2D-STE parameters of the diabetic group were compared.
Results: The median age of the study population was 52.0 (46.0-58.0, IQR), and 48 (52.1%) were female. The left ventricle global longitudinal strain (LV-GLS), left ventricle global circumferential strain (LV-GCS), and left ventricular global radial strain (LV-GRS) were less in the diabetic group than in the control group (p value < 0.001, < 0.001, and < 0.001, respectively). There was a significant increase in the LV-GCS compared to before empagliflozin treatment (-20.0 [-17.6;-20.9] vs -19.2 [-17.5;-20.2], p= 0.005 and -18.9 [-16.0;-20.8] vs -17.1 [-15.8;-18.7], p= 0.003, respectively). Although the LV-GRS increased compared to baseline, it the change was not significant (37.0 [31.0-41.6] vs 36.3 [32.4-40.3], p= 0.776).
Conclusion: In our study, after empagliflozin treatment left ventricular myocardial strain parameters such as LV-GLS and LV-GCS were improved in patients with type-2 DM and normal EF.

Keywords

Diabetes mellitus, Empagliflozin, Strain.

References

• 1.Gallo LA, Wright EM, Vallon V. Probing SGLT2 as atherapeutic target for diabetes: basic physiology and consequences. Diab Vasc Dis Res 2015; 12: 78–89.doi: 10.1177/1479164114561992.
• 2.Zinman B, Wanner C, Lachin JM, et al. EMPA-REGOUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2diabetes.N Engl J Med. 2015; 373:2117–2128. doi:10.1056/NEJMoa1504720.
• 3.Verma S, Mazer CD, Al-Omran M, et al.Cardiovascular outcomes and safety ofempagliflozin in patients with type 2 diabetesmellitus and peripheral artery disease: a subanalysis of EMPA-REG OUTCOME. Circulation. 2018;137:405–407. doi:10.1161/CIRCULATIONAHA.117.032031.