Echocardiographic Associations and Short-Term Safety of Dapagliflozin Among Non-Diabetic Egyptian Patients With Heart Failure With Reduced Ejection Fraction: A Prospective Single-Arm Observational Cohort Study

Objective: This study aimed to assess the echocardiographic correlates and short-term safety of sodium-glucose co-transporter 2 inhibitor dapagliflozin in non-diabetic Egyptian patients with heart failure with reduced ejection fraction (HFrEF). Methods: This prospective single-arm cohort study enrolled stable non-diabetic HFrEF outpatients from Ain Shams University Hospital (Cairo, Egypt) between September 2021 and January 2023. All subjects received dapagliflozin 10 mg daily as add-on therapy to guideline-directed medical therapy, with treatment decisions independently made by attending physicians in routine clinical practice rather than assigned by the research team. Serial echocardiograms were performed at the 6-month follow-up per European Association of Cardiovascular Imaging standards. Repeated-measures ANOVA was used to compare serial cardiac ultrasound parameters. Of 55 initially eligible patients, 2 were lost to follow-up, leaving 53 patients in the final analytical cohort. Adverse events were prospectively monitored for safety assessment. Results: The 53 analyzable participants were predominantly male ( n = 33, 62%), with a mean age of 56 years and a mean body mass index of 31.0 kg/m 2 . After 6 months of treatment, dapagliflozin was associated with a significant improvement in all left ventricular systolic and diastolic echocardiographic parameters, including increased left ventricular ejection fraction and reduced left ventricular end-diastolic volume and left ventricular end-systolic volume (all P <0.001). Mild adverse events were observed in 8 of 53 patients (15%): hypoglycemia ( n = 2, 4%), urinary tract infections ( n = 2, 4%), genital mycotic infections ( n = 4, 8%). No symptomatic hypotension was recorded throughout follow-up. Conclusions: Adjunct dapagliflozin treatment was correlated with significant serial improvements in left ventricular systolic and diastolic echocardiographic remodeling markers over 6 months, with a mild, well-tolerated short-term adverse event profile. This observational design cannot establish causal relationships, and findings are limited to this Egyptian patient population without external control group validation.