Early SGLT2 Inhibitor Use is Associated with Improved Left Atrial Reservoir and Contractile Function Following Acute Coronary Syndrome in Patients with Type 2 Diabetes

Purpose Left atrial (LA) strain, a novel marker of LA function, reliably predicts diastolic dysfunction and outperforms conventional parameters. SGLT2 inhibitors improve heart failure outcomes, but limited data exists regarding their use in the immediate aftermath of acute coronary syndrome (ACS). We studied the effect of empagliflozin on LA strain in patients with type 2 diabetes (T2D) and ACS. Methods Patients with ACS and T2D were identified and empagliflozin was initiated in eligible patients prior to discharge. Patients not initiated on empagliflozin were analysed as a comparator group. A blinded investigator assessed LA strain using baseline and 3–6 month follow-up echocardiograms. Results Forty-four participants (n = 22 each group) completed the study. Baseline characteristics were similar (age 60.8 ± 9.5 vs 65.1 ± 10.4 years, LA volume 32.2 ± 9.4ml/m 2 vs 35.2 ± 11.6ml/m 2 , left ventricular ejection fraction 51.1 ± 11.3% vs 54.9 ± 10.8%; p = NS) in the two groups, except HbA1c was higher in empagliflozin group (9.8 ± 1.6% vs 6.6 ± 0.7%, p < 0.001). Baseline LA strain was similar between groups (reservoir 28.0 ± 8.4% vs 29.2 ± 6.7%, conduit 14.5 ± 5.4% vs 12.8 ± 4.2%, contractile 13.5 ± 5.2% vs 16.5 ± 5.3%; p = NS). LA reservoir, conduit and contractile strain increased in empagliflozin group (28.0 ± 8.4% to 34.6 ± 12.2% p < 0.001, 14.5 ± 5.4% to 16.7 ± 7.0% p = 0.034, 13.5 ± 5.2% to 17.9 ± 7.2% p = 0.005 respectively) but remained unchanged in comparison group (29.2 ± 6.7% to 28.8 ± 7.0%, 12.8 ± 4.2% to 13.3 ± 4.7%, 16.7 ± 5.3% to 15.5 ± 4.5% respectively, p = NS). The difference in change between groups was significant for LA reservoir (p = 0.003) and contractile strain (p = 0.005). Conclusion In patients with ACS and T2D, addition of empagliflozin to standard ACS therapy prior to discharge is associated with improved LA function. Larger studies are warranted to determine clinical implications.