Key result
Sitagliptin linked to ~5% higher peak stress LVEF in patients with T2D and CAD.
Why the study?
Does sitagliptin improve ischemic left ventricular dysfunction during dobutamine stress in patients with type 2 diabetes mellitus and coronary artery disease?
Does sitagliptin improve ischemic left ventricular dysfunction during dobutamine stress in patients with type 2 diabetes mellitus and coronary artery disease?
Absolute Event Rate: 70.5% vs 65.7%
p-value: p=<0.0001
In a pilot study of patients with T2DM and CAD, the addition of sitagliptin for 4 weeks improved myocardial performance during dobutamine stress and reduced postischemic stunning.
May improve stress-induced LV function in T2DM with CAD; leaves open whether DPP-4 inhibition affects clinical outcomes.
BACKGROUND: The incretin hormone, glucagon-like peptide-1, promotes myocardial glucose uptake and may improve myocardial tolerance to ischemia. Endogenous glucagon-like peptide-1 (7-36) is augmented by pharmacological inhibition of dipeptidyl peptidase-4. We investigated whether chronic dipeptidyl peptidase-4 inhibition by sitagliptin protected against ischemic left ventricular dysfunction during dobutamine stress in patients with type 2 diabetes mellitus and coronary artery disease. METHODS AND RESULTS: A total of 19 patients with type 2 diabetes mellitus underwent dobutamine stress echocardiography with tissue Doppler imaging on 2 separate occasions: the first (control) while receiving oral hypoglycemic agents, and the second after the addition of sitagliptin (100 mg once daily) for ≈4 weeks. Sitagliptin increased plasma glucagon-like peptide-1 (7-36) levels and, at peak stress, enhanced both global (ejection fraction, 70.5±7.0 versus 65.7±8.0%; P<0.0001; mitral annular systolic velocity, 11.7±2.6 versus 10.9±2.3 cm/s; P=0.01) and regional left ventricular function, assessed by peak systolic velocity and strain rate in 12 paired, nonapical segments. This was predominantly because of a cardioprotective effect on ischemic segments (strain rate in ischemic segments, -2.27±0.65 versus -1.98±0.58 s(-1); P=0.001), whereas no effect was seen in nonischemic segments (-2.19±0.48 versus -2.18±0.54 s(-1); P=0.87). At 30 minutes recovery, dipeptidyl peptidase-4 inhibition mitigated the postischemic stunning seen in the control scan. CONCLUSIONS: The addition of dipeptidyl peptidase-4 inhibitor therapy with sitagliptin to the treatment regime of patients with type 2 diabetes mellitus and coronary artery disease is associated with a sustained improvement in myocardial performance during dobutamine stress and a reduction in postischemic stunning. CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.org. Unique identifier ISRCTN61646154.
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Kydd et al. (2014) studied Type 2 diabetes mellitus and coronary artery disease (n=19). Sitagliptin vs. Control (oral hypoglycemic agents) was evaluated on Global ejection fraction at peak stress (p=<0.0001). Sitagliptin (100 mg once daily) for 4 weeks improved global ejection fraction at peak stress compared to control (70.5% vs 65.7%; P<0.0001) in patients with type 2 diabetes and coronary artery disease.
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