Effect of SGLT2 inhibitors on left atrial strain in patients of acute coronary syndrome and diabetes mellitus

Purpose To evaluate the effect of effect of Sodium–Glucose Co-Transporter 2 (SGLT2) Inhibitors on left atrial (LA) deformation and heart failure biomarkers in patients with Acute coronary syndrome (ACS) and diabetes mellitus (DM) Methods This prospective, case-control, single-center study enrolled 50 diabetic patients with recent ACS (<14 days). Participants were randomized into SGLT2i (empagliflozin/ dapagliflozin, n=25) and control (n=25) group. Echocardiographic parameters including LA strain by speckle-tracking echocardiography and NT-proBNP levels were assessed at baseline and 3 months. Results Baseline characteristics were comparable between groups. At 3-month follow-up, SGLT2i group demonstrated significant improvement in LA reservoir (29.08±7.23% to 33.36±6.45%, p<0.001), contractile strain (-17.16±5.27% to -19.88±5.41%, p=0.002), and conduit strain in 4-chamber view (-13.12±4.75% to -14.56±3.96%, p=0.007). Left ventricular systolic and diastolic functions also improved, with significant increases in LVEF (49.9% to 51.9%, p<0.001), reductions in E/e′ and LVESV, and enhanced GLS. NT-proBNP decreased markedly in the SGLT2i group (5541.6±8443.5 to 1179.6±1644.6 pg/ml, p=0.004). In the control group, only modest improvements in selected parameters were noted. Conclusions Early initiation of SGLT2 inhibitors in post-ACS diabetic patients significantly improved LA strain, LV remodelling and NT-proBNP, suggesting favourable cardiac reverse remodelling. These findings support the early incorporation of SGLT2i in secondary prevention strategies post-ACS, though larger trials with long-term outcomes are warranted.