Dapagliflozin administration in patients with chronic heart failure significantly reduced maximal left atrial volume index by 6.6% (95% CI -11.1 to -1.8; p=0.008) over 180 days.
Does dapagliflozin improve cardiac remodelling parameters in patients with stable chronic heart failure?
Dapagliflozin administration in stable chronic heart failure patients leads to significant reverse cardiac remodelling, including reductions in left atrial volume and improved left ventricular geometry.
Effect estimate: -6.6% (95% CI -11.1, -1.8)
p-value: p=0.008
ABSTRACT Aims Dapagliflozin improves the prognosis of patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF). However, its effect on cardiac remodelling parameters, specifically left atrial (LA) remodelling, is not well established. Methods and results The DAPA-MODA trial (NCT04707352) is a multicentre, single-arm, open-label, prospective and interventional study that aimed to evaluate the effect of dapagliflozin on cardiac remodelling parameters over 6 months. Patients with stable chronic HF receiving optimized guideline-directed therapy, except for any sodium–glucose cotransporter 2 inhibitor, were included. Echocardiography was performed at baseline, 30 and 180 days, and analysed by a central core-lab in a blinded manner to both patient and time. The primary endpoint was the change in maximal LA volume index (LAVI). A total of 162 patients (64.2% men, 70.5 ± 10.6 years, 52% LVEF >40%) were included in the study. At baseline, LA dilatation was observed (LAVI 48.1 ± 22.6 ml/m2) and LA parameters were similar between LVEF-based phenotypes (≤40% vs. >40%). LAVI showed a significant reduction at 180 days (−6.6% 95% confidence interval −11.1, −1.8, p = 0.008), primarily due to a decrease in reservoir volume (−13.8% 95% confidence interval −22.5, −4, p = 0.007). Left ventricular geometry improved with significant reductions in left ventricular mass index (−13.9% 95% confidence interval −18.7, −8.7, p < 0.001), end-diastolic volume (−8.0% 95% confidence interval −11.6, −4.2, p < 0.001) and end-systolic volume (−11.9% 95% confidence interval −16.7, −6.8, p < 0.001) at 180 days. N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed a significant reduction at 180 days (−18.2% 95% confidence interval −27.1, −8.2, p < 0.001), without changes in filling Doppler measures. Conclusion Dapagliflozin administration in stable out-setting patients with chronic HF and optimized therapy results in global reverse remodelling of cardiac structure, including reductions in LA volumes and improvement in left ventricular geometry and NT-proBNP concentrations.
Pascual‐Figal et al. (2023) studied Chronic heart failure (n=162). Dapagliflozin was evaluated on Change in maximal LA volume index (LAVI) (-6.6%, 95% CI -11.1, -1.8, p=0.008). Dapagliflozin administration in patients with chronic heart failure significantly reduced maximal left atrial volume index by 6.6% (95% CI -11.1 to -1.8; p=0.008) over 180 days.