Improvement of Global Longitudinal Strain and Myocardial Work in Type 2 Diabetes Patients on Sodium–glucose Cotransporter 2 Inhibitors Therapy

Introduction Sodium–glucose cotransporter 2 inhibitors (SGLT2–i) are a novel class of oral hypoglycaemic agents currently used among patients with type 2 diabetes mellitus (T2DM). The effects of SGLT2–i inhibitors on cardiac structure and function are not fully understood. The aim of the present study is to evaluate the echocardiographic changing among patients with well–controlled TDM2 treated with SGLT2–i inhibitors in real–world setting. Materials and Methods 35 well–controlled T2DM patients (65± 9 years, 43.7% male) with preserved left ventricular ejection fraction and 35 age and sex–matched controls were included. T2DM patients underwent clinical and laboratory evaluation; 12–lead surface electrocardiogram (ECG); 2–dimensional color Doppler echocardiography at enrolment, before SGLT2–i administration, and at six months follow–up after an uninterrupted 10 mg once daily of Empagliflozin (n: 21) or Dapagliflozin (n: 14). Standard echocardiographic measurements, LV global longitudinal strain (LV–GLS), global wasted work (GWW) and global work efficiency (GWE) were calculated. Results T2DM patients showed higher EE’ ratio (8.3± 2.5 vs. 6.3± 0.9; p< 0.0001) and lower LV– GLS (15.8 ± 8.1 vs. 22.1± 1.4%; P<0.0001) and global myocardial work efficiency (91± 4 vs 94± 3%; P: 0.0007) compared to age and sex–matched controls. At six–months follow–up, T2DM patients showed a significant increase in LVEF (58.9± 3.2 vs 62± 3.2; p<0.0001), LV–GLS (16.2± 2.8 vs 18.7± 2.4%; p=0.003) and GWE (90.3± 3.5 vs 93.3± 3.2%; P= 0.0004) values; conversely, GWW values (161.2± 33.6 vs 112.72± 37.3 mmHg%; P<0.0001) significantly decreased. Conclusions SGLT2–I therapy showed a significant anti–remodelling effectiveness, improving the LV–GLS and MWE, among well–controlled diabetic patients with preserved left ventricular ejection fraction.