P1 Analysis of cardiac MRI scans to assess the effect of dapagliflozin on epicardial adipose tissue (EAT)

Introduction Epicardial adipose tissue (EAT) accumulation is a significant risk factor for heart failure. The relationship between EAT thickness and their impact on patients who have diabetes and heart failure remains unclear. Dapagliflozin, a key heart failure treatment, blocks the kidney's SGLT2 protein, reducing glucose reabsorption and lowering blood sugar. Beyond controlling blood sugar, dapagliflozin causes diuresis and reduces cardiovascular deaths and heart failure hospitalisations. Our aim was to analyse cardiac MRI scans to assess dapagliflozin's effect on EAT thickness, exploring its potential role in heart failure management. Methods In a secondary analysis of the REFORM clinical trial, 56 individuals with type 2 diabetes and heart failure were randomised to receive either dapagliflozin or a placebo. The evaluation involved cardiac magnetic resonance (CMR) scans at baseline and at 12 months post-treatment. Epicardial fat was measured utilizing 4-chamber cine images to quantify adipose tissue between the myocardium and the visceral layer of the pericardium. This assessment was carried out using the single end-diastolic image, with measurements conducted by evaluators blinded to the randomisation status of participants. Results 47 participants completed the study. The placebo group, including 23 participants, exhibited a minimal average epicardial fat change of 0.09 cm² (baseline: 11.54 cm², 12 months: 11.52 cm²). The dapagliflozin group, comprising 24 participants, showed a significant reduction, with a mean change of 1.21 cm² (baseline: 11.74 cm², 12 months: 10.63 cm², p<0.007 compared to placebo). Conclusion Dapagliflozin significantly reduced epicardial adipose tissue compared to placebo in patients with type 2 diabetes and heart failure. The reduction in EAT may play a role in the beneficial effects of dapagliflozin in heart failure patients.