Dapagliflozin effects depending on the localization of acute myocardial infarction: a prospective clinical study

Background. Acute myocardial infarction remains a leading cause of mortality worldwide despite significant advances in reperfusion therapy. In most patients, the post-infarction period is characterized by myocardial remodeling, which determines long-term prognosis and the development of chronic heart failure. Increasing attention is being paid to metabolic and structural cardiac changes depending on infarct localization and the influence of modern cardioprotective therapies. Sodium-glucose cotransporter type 2 inhibitors have demonstrated the ability to reduce the risk of cardiovascular complications; however, their effect on the course of acute myocardial infarction with different infarct localizations during the early phase of the disease remains insufficiently studied. Purpose – to evaluate the effect of early administration of dapagliflozin on the dynamics of epicardial adipose tissue thickness and the level of N-terminal pro–B-type natriuretic peptide during 30 days in patients with acute myocardial infarction of anterior and inferior localization. Materials and methods. The study included 78 patients with acute myocardial infarction who were stratified according to infarct localization: anterior (n = 50) and inferior (n = 28). Myocardial infarction with and without Q-wave formation was determined according to electrocardiographic criteria. Within each subgroup, patients who received dapagliflozin from the first day of hospitalization (10 mg per day) were compared with a control group without therapy with sodium-glucose cotransporter type 2 inhibitors. The dynamics of epicardial adipose tissue thickness and the level of N-terminal pro–B-type natriuretic peptide were assessed during a 30-day follow-up period. Statistical analysis included parametric and non-parametric methods depending on data distribution. Results. The most pronounced and statistically significant changes were observed in patients with Q-wave myocardial infarction. In patients with anterior Q-wave myocardial infarction treated with dapagliflozin, a significant reduction in epicardial adipose tissue thickness and the level of N-terminal pro–B-type natriuretic peptide was observed compared with the control group. Similar trends were found in patients with inferior myocardial infarction. In patients without Q-wave formation, the reduction of the studied parameters was less pronounced and did not always reach statistical significance. Conclusions. Within 30 days after acute myocardial infarction, changes in epicardial adipose tissue thickness and the level of N-terminal pro–B-type natriuretic peptide were associated with infarct localization and the presence of a pathological Q wave. Early administration of dapagliflozin was associated with a more pronounced reduction of these parameters, suggesting a potential role of sodium-glucose cotransporter type 2 inhibitors in the modification of post-infarction remodeling.