Reduction of cardiac adipose tissue volume with short‐term empagliflozin treatment in patients with type 2 diabetes: A substudy from the SIMPLE randomized clinical trial

Figures

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  FIGURE 1. Cardiac‐specific changes and changes in adipose tissue mass following short‐term empagliflozin treatment in patients with type 2 diabetes and established cardiovascular risk. Evidence suggests accumulation of cardiac adipose tissue has detrimental effects on cardiac remodelling through metabolic and inflammatory pathways. In the current substudy of the SIMPLE trial, a short regimen with 25 mg empagliflozin led to a decrease in cardiac adipose tissue [treatment effect: −12.41 ml 95% CI (−23.83 to −0.99), p = .034] and showed evidence of left ventricular mass regression indexed to body surface area [treatment effect: −2.47 g/m2 95% CI (−4.14 to −0.80), p = .004] as well as a change in body composition by a decrease in adipose tissue mass [treatment effect: −0.81 kg 95% CI (−1.40 to −0.22), p = .008] when comparing groups at week 13. However, changes in cardiac adipose tissue volume appeared mainly mediated by changes in weight, and were not correlated with changes in left ventricular mass, suggesting parallel phenomena rather than a direct of effect mediated by sodium‐glucose cotransporter 2 inhibitor (SGLT2‐i) treatment

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  FIGURE 2. Process of quantifying cardiac adipose tissue and left ventricular mass. (A) The fibrous layer of the pericardial sac was delineated automatically, resulting in a total cardiac volume. Adipose tissue contained therein was derived using the specific density of fat (−150 to −50 Hounsfield units), giving a volume including both paracardial and epicardial adipose tissue. (B) The epi‐ and endocardial border were delineated automatically to derive left ventricular mass, end‐diastolic and end‐systolic volume

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  FIGURE 3. Effect modification according to post‐hoc defined subgroups by baseline values. No significant effect modification was observed on the effect of sodium‐glucose cotransporter 2 inhibitor on the primary focus, cardiac adipose tissue