Effects of SGLT2 Inhibition on Cardiac Structure, Left Atrial Function, and Fibrotic Biomarkers in HFpEF with Type 2 Diabetes
Abstract
Heart failure with preserved ejection fraction (HFpEF) frequently occurs in patients with type 2 diabetes mellitus (T2DM) and is characterized by diastolic dysfunction, left atrial (LA) remodeling, and myocardial fibrosis. Although sodium–glucose co-transporter-2 inhibitors (SGLT2i) improve outcomes in HFpEF, their effects on cardiac structure, LA function, and profibrotic biomarkers remain incompletely understood. In this prospective single-center study, 31 patients with T2DM and HFpEF naïve to SGLT2i were enrolled and received empagliflozin or dapagliflozin in addition to guideline-directed therapy; 26 patients completed follow-up and were included in the final analysis. Cardiac magnetic resonance (CMR), transthoracic echocardiography, and laboratory assessments were performed at baseline and after 24 weeks. Ventricular volumes, mass index, LA volume index, and LA reservoir strain (LARS) were evaluated. Circulating galectin-3, NT-proBNP, and heart fatty acid binding protein (H-FABP) levels were measured. After 24 weeks, CMR showed significant reductions in left ventricular volumes and mass index (p < 0.05). LA volume index decreased and LARS increased significantly (p < 0.01). Echocardiography demonstrated increased lateral e′ velocity and reduced systolic pulmonary artery pressure. Galectin-3 levels decreased significantly (p < 0.05), while NT-proBNP and H-FABP levels remained unchanged. SGLT2 inhibitor therapy was associated with favorable cardiac remodeling, improved LA…
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