Longitudinal Assessment of Diastolic Function and Myocardial Strain in Type 2 Diabetes: A Comparison of Empagliflozin and Linagliptin
Abstract
Objective: The cardiovascular effects of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors have attracted increasing interest in patients with type 2 diabetes mellitus. This study aimed to compare the time-dependent effects of empagliflozin and linagliptin on left ventricular diastolic function and global longitudinal strain (GLS).
Methods: This prospective longitudinal study included 350 patients with type 2 diabetes mellitus treated with empagliflozin (n = 200) or linagliptin (n = 150). Transthoracic echocardiography and speckle-tracking strain analysis were performed at baseline, 1 month, and 6 months. Diastolic function was evaluated using septal e' velocity, E/e' ratio, isovolumetric relaxation time (IVRT), and mitral E-wave deceleration time. Longitudinal changes were analyzed using linear mixed-effects models including treatment group, time, and group × time interaction.
Results: Diastolic function parameters improved significantly over time in both groups (all P < .001). At follow-up, HbA1c levels decreased in both groups, with comparable glycemic control achieved at 6 months. Significant group × time interactions were observed for septal e' velocity, E/e' ratio, and IVRT (all P < .001). These findings remained consistent after adjustment for baseline differences. At 6 months, empagliflozin was associated with greater improvement in septal e' velocity and IVRT, whereas linagliptin resulted in a more pronounced reduction in the E/e'…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 350 participants or records.
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