Effect of Dapagliflozin on Cardiac Structure and Function in Patients with Heart Failure Due to Mildly Reduced Ejection Fraction

Mengdan XU; Hong XIANG; Xiaolong GAO; Jin ZHANG; Haiyan WU; Lilin WANG

Article Contents

Article Navigation > Journal of Kunming Medical University > 2024 >

Mengdan XU, Hong XIANG, Xiaolong GAO, Jin ZHANG, Haiyan WU, Lilin WANG. Effect of Dapagliflozin on Cardiac Structure and Function in Patients with Heart Failure Due to Mildly Reduced Ejection Fraction[J]. Journal of Kunming Medical University.

Citation:

PDF( 723 KB)

Effect of Dapagliflozin on Cardiac Structure and Function in Patients with Heart Failure Due to Mildly Reduced Ejection Fraction

Dept. of Cardiology，The Affiliated Hospital of Kunming University of Science and Technology/The 1st People’s Hospital of Yunnan Province，Kunming Yunnan 650032，China

Received Date: 2024-05-12
Available Online: 2024-11-09

Abstract

Abstract

Objective To investigate the effects of dapagliflozin on cardiac structure and function in patients with heart failure due to mildly reduced ejection fraction. Methods Patients diagnosed with heart failure due to mildly reduced ejection fraction in the outpatient department and inpatient department of the First People's Hospital of Yunnan Province from November 1, 2021 to December 31, 2022 were selected and divided into the conventional anti-heart failure group and dapagliflozin group according to whether they were taking dapagliflozin or not. The conventional anti-heart failure group received the conventional anti-heart failure treatment （loop diuretics, ACEI/ARB/ARNI, spironolactone, β-blocker）, and the dapagliflozin group was given oral dapagliflozin on the basis of conventional anti-heart failure treatment. The improvement of cardiac function, LVEDD （left ventricular end-diastolic diameter）, LVESD （left ventricular end-systolic diameter）, LVEF （left ventricular ejection fraction）, IVST （ventricular septum thickness）, LVPWT （left ventricular posterior wall thickness）, LAD （left atrial diameter） and the incidence of adverse events after the treatment within 3 months, 6 months and 1 year were observed in both groups. Results 33 patients in the dapagliflozin group and 37 patients in the conventional anti-heart failure group completed the follow-up. （1）After 3 months, 6 months and 1 year of thefollow-up, the NYNH cardiac function grade of the two groups was improved compared with that before the treatment and the total effective rate of the dapagliflozin group was significantly higher than that of the conventional anti-heart failure group（P < 0.05）.（2）LVEF increased compared with the baseline in both groups, while LVEDD, LVESD, LAD, IVST and LVPWT decreased compared with the baseline（P < 0.05）.（3）After 3 months of treatment , there was no significant difference between LVEF, LVEDD, LVESD, LAD and IVST at 3 months（P > 0.05）and the decrease of LVPWT in dapagliflozin group was significantly higher than that in conventional anti-heart failure group. （4）After 6 months and 1 year of the treatment, the increase of LVEF and the decrease of LAD, IVST and LVPWT in dapagliflozin group were significantly higher than those in conventional anti-heart failure group （P < 0.05）.There was no significant difference in the decrease degree of LVEDD and LVESD between the two groups at 6 months after the treatment（P > 0.05） and the difference was significant at 1 year after the treatment（P < 0.05）. Conclusion On the basis of standardized anti-heart failure drug therapy, the combination of dapagliflozin can further improve the cardiac remodeling and function of patients with heart failure due to mildly reduced ejection fraction.
- Dapagliflozin,
- Heart failure with mildly reduced ejection fraction,
- Cardiac remodeling,
- Cardiac function

FullText(HTML)

References(25)

References

[1]	Zhang Y,Zhang J,Butler J,et al. China-HF innvestigators. Contemporary epidemiology,eanagement,and outcomes of patients hospitalized for heart failure in China: Results from the China heart failure ( China-HF) registry[J]. J Card Fail,2017,23(12):868-875. doi: 10.1016/j.cardfail.2017.09.014
[2]	McDonagh T A,Metra M,Adamo M,et al. ESC scientific document group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J,2021,42(36):3599-3726. doi: 10.1093/eurheartj/ehab368
[3]	Heidenreich P A,Bozkurt B,Aguilar D,et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. J Am Coll Cardiol,2022,79(17):1757-1780. doi: 10.1016/j.jacc.2021.12.011
[4]	McMurray J J V,Solomon S D,Inzucchi S E,et al. DAPA-HF trial committees and investigators. Dapagliflozin in patients with heart failure and reduced ejection fraction[J]. N Engl J Med,2019,381(21):1995-2008. doi: 10.1056/NEJMoa1911303
[5]	Savarese G,Stolfo D,Sinagra G,et al. Heart failure with mid-range or mildly reduced ejection fraction[J]. Nat Rev Cardiol,2022,19(2):100-116. doi: 10.1038/s41569-021-00605-5
[6]	Chioncel O,Lainscak M,Seferovic P M,et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved,mid-range and reduced ejection fraction: An analysis of the ESC heart failure long-term registry[J]. Eur J Heart Fail,2017,19(12):1574-1585. doi: 10.1002/ejhf.813
[7]	中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志,2018,46(10):760-789.
[8]	Solomon S D,De Boer R A,DeMets D,et al. Dapagliflozin in heart failure with preserved and mildly reduced ejection fraction: Rationale and design of the DELIVER trial[J]. Eur J Heart Fail,2021,23(7):1217-1225. doi: 10.1002/ejhf.2249
[9]	Cure E,Cumhur Cure M. Comment on: "High released lactate by epicardial fat from coronary artery disease patients is reduced by dapagliflozin treatment"[J]. Atherosclerosis,2020,296(1):2-3.
[10]	Das U S,Paul A,Banerjee S. SGLT2 inhibitors in heart failure with reduced ejection fraction[J]. Egypt Heart J,2021,73(1):93-99. doi: 10.1186/s43044-021-00218-w
[11]	Butt J H,Lu H,Kondo T,et al. Heart failure,chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction: Insights from DELIVER[J]. Eur J Heart Fail,2023,25(11):2078-2090. doi: 10.1002/ejhf.3000
[12]	Solomon S D,Vaduganathan M,L Claggett B,et al. Sacubitril/valsartan across the spectrum of ejection fraction in heart failure[J]. Circulation,2020,141(5):352-361. doi: 10.1161/CIRCULATIONAHA.119.044586
[13]	Anker S D,Butler J,Filippatos G,et al. EMPEROR-preserved trial investigators. Empagliflozin in heart failure with a preserved ejection fraction[J]. N Engl J Med,2021,385(16):1451-1461. doi: 10.1056/NEJMoa2107038
[14]	Solomon S D,McMurray J,Claggett B,et al. DELIVER trial committees and investigators. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction[J]. N Engl J Med,2022,387(12):1089-1098. doi: 10.1056/NEJMoa2206286
[15]	Lee M M Y,Brooksbank K J M,Wetherall K,et al. Effect of empagliflozin on left ventricular volumes in patients with type 2 diabetes,or prediabetes,and heart failure with reduced ejection fraction (SUGAR-DM-HF)[J]. Circulation,2021,143(6):516-525. doi: 10.1161/CIRCULATIONAHA.120.052186
[16]	Santos-Gallego C G,Vargas-Delgado A P,Requena-Ibanez J A,et al. EMPA-TROPISM (ATRU-4) investigators. Randomized trial of empagliflozin in nondiabetic patients with heart failure and reduced ejection fraction[J]. J Am Coll Cardiol,2021,77(3):243-255. doi: 10.1016/j.jacc.2020.11.008
[17]	Chan Y H,Hsu T J,Wang C L,et al. Sodium glucose cotransporter-2 inhibitor was associated with an improvement in left ventricular systolic function in patients with type 2 diabetes mellitus with impaired left ventricular systolic function[J]. ESC Heart Fail,2020,7(5):2784-2796. doi: 10.1002/ehf2.12877
[18]	Lan N S R,Fegan P G,Yeap B B,et al. The effects of sodium-glucose cotransporter 2 inhibitors on left ventricular function: Current evidence and future directions[J]. ESC Heart Fail,2019,6(5):927-935. doi: 10.1002/ehf2.12505
[19]	Mudaliar S,Alloju S,Henry R R. Can a shift in fuel energetics explain the beneficial cardiorenal outcomes in the EMPA-REG OUTCOME study? A unifying hypothesis[J]. Diabetes Care,2016,39(7):1115-1122. doi: 10.2337/dc16-0542
[20]	Yurista S R,Silljé H H W,Van Goor H,et al. Effects of sodium-glucose co-transporter 2 inhibition with empaglifozin on renal structure and function in non-diabetic rats with left ventricular dysfunction after myocardial infarction[J]. Cardiovasc Drugs Ther,2020,34(3):311-321. doi: 10.1007/s10557-020-06954-6
[21]	Lee T M,Chang N C,Lin S Z. Dapagliflozin,a selective SGLT2 inhibitor,attenuated cardiac fibrosis by regulating the macrophage polarization via STAT3 signaling in infarcted rat hearts[J]. Free Radic Biol Med,2017,104(1):298-310.
[22]	Lupón J,Gavidia-Bovadilla G,Ferrer E,et al. Heart failure with preserved ejection fraction infrequently evolves toward a reduced phenotype in long-term survivors[J]. Circ Heart Fail,2019,12(3):e005652. doi: 10.1161/CIRCHEARTFAILURE.118.005652
[23]	Miller R J H,Nabipoor M,Youngson E,et al. Heart failure with mildly reduced ejection fraction: Retrospective study of ejection fraction trajectory risk[J]. ESC Heart Fail,2022,9(3):1564-1573. doi: 10.1002/ehf2.13869
[24]	Uthman L,Homayr A,Juni RP,et al. Empagliflozin and dapagliflozin reduce ROS generation and restore NO bioavailability in tumor necrosis factor α-stimulated human coronary arterial endothelial cells[J]. Cell Physiol Biochem,2019,53(5):865-886. doi: 10.33594/000000178
[25]	Wiviott S D,Raz I,Bonaca M P,et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med,2019,380(4):347-357. doi: 10.1056/NEJMoa1812389

Relative Articles(20)

Relative Articles

[1]	Mengxue LIU, Jia MIAO, Xuehe SHENG. Correlation between Blood UA，Smad1 Protein，Urine mALB Levels and the Therapeutic Effect of Dapagliflozin in Patients with Type 2 Diabetes Nephropathy. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240425
[2]	Changyong WU, Rui WANG, Suli BAO, Ruijie LI, Huang SUN, Yujia YE, Fei XU, Yunzhu PENG. Effects of Exercise Rehabilitation on Cardiac Fibrosis and Function in Rats with Myocardial Infarction. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20231004
[3]	Danhong DONG, Weiwen WANG, Dexia LI, Jun YANG, Na LI, Hang MA, Lin LI. Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan： a Single-center Survey. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230822
[4]	Jianpei SU, Miyu HE, Yongli WANG, Qi WU, Weimeng TIAN, Jin LI, Bijuan LIANG. To Investigate the Application Effect of Dapagliflozin in Elderly Patients with HFpEF and Type 2 Diabetes Mellitus and Its Effect on Inflammatory Factors. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230405
[5]	Yao YANG, Jianxiong LIU, Yun ZHANG, Fanyi KONG, Shixiang LIU. Relationships between Large Artery Atherosclerotic Stroke and Cardiac Function. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20221126
[6]	Mei CEN, Dan-dan YUAN, Ming JIN, Xue-lian LIU, Wei-wei SHANG. Effect of Cardiac Exercise Rehabilitation on Cardiac Function and Quality of Life in Patients with Hypertensive Heart Disease Complicated with Heart Failure. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210520
[7]	Wei-wen WANG, De-xia LI, Jie ZHANG, Lin LI. Correlation Between Serum Soluble ST2 and Cardiac Remodeling in Patients with Heart Failure with Reduced Ejection Fraction. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210813
[8]	Yi ZENG, Yun-juan LIAO, Ying LI, Zhen-kun HE. Efficacy of Dapagliflozin on Early Diabetic Nephropathy and Its Effect on Serum MCP-1 and IL-6. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20211218
[9]	Li Yun Ling , Bao Tian Hao , Zhang Ya Zhou , Tian Wei Meng , Mao Wen Wen , Hu Xiao Yun , Li Hua , Gu Jun . . Journal of Kunming Medical University,
[10]	Jiang Hong Ying , Dou Li Na , Liao Yun Juan , Zeng Yi , Bai Yi Hua , Yang Min . Clinical Value of Myocardial Injury Markers in Evaluating Cardiac Structure and Function of Chronic Kidney Disease Patients without Dialysis. Journal of Kunming Medical University,
[11]	Shi Hu Tao , Song Guang Yi , Long Zhi Gang . Magnetic Resonance Imaging Study of Cardiac Atrioventricular Line and Ventricular Systolic Function in Population of Kunming. Journal of Kunming Medical University,
[12]	Chen Zong Ning . The Impact of Autocapture Function on the Service life of Cardiac Pacemaker. Journal of Kunming Medical University,
[13]	Li Yan Ping . The Clinical Characteristics of Patients with Chronic Heart Failure with Preserved Ejection Fraction. Journal of Kunming Medical University,
[14]	Luo Yong Li . Clinical Assessment on the Safety of Cardiac Rehabilitation for the Elderly Patients with Chronic Heart Failure. Journal of Kunming Medical University,
[15]	Tao Si Ming . Effects of Cardiac Shock Wave Therapy on Myocardial Collateral Circulation and Global Cardiac Function after Acute Myocardial Infarction at Early Stage in Pigs. Journal of Kunming Medical University,
[16]	Ding Yun Chuan . . Journal of Kunming Medical University,
[17]	Dai Hai Long . . Journal of Kunming Medical University,
[18]	Guo Yue. . Journal of Kunming Medical University,
[19]	Yan Qing Feng . Effects of Luteolin on Isolated Heart Function and Oxidative Stress Reaction after Hypothermic Preservation. Journal of Kunming Medical University,
[20]	Ma Li Ming . . Journal of Kunming Medical University,