Dapagliflozin ameliorates arterial stiffness, endothelial glycocaclyx and myocardial performance in non-diabetic STEMI patients: a 3-month follow-up study

Background Sodium glucose Cotransporter-2 inhibitor (SGLT2i) have been recently administered efficiently in the acute phase of Acute Myocardial Infarctions (AMI) in patients without diabetes or heart failure. Purpose We aimed to address the effects of dapagliflozin in arterial wall elastic properties, thickness of endothelial glycocalyx and myocardial performance in STEMI participants. Methods We included participants hospitalized in the Cardiology Unit for STEMI without diabetes or heart failure. Patients were commenced on 10 mg dapagliflozin as an add-on to the standard of care treatment upon discharge for the index event. We also entailed a control group of STEMI patients with similar age, sex and risk factors by propensity score matching (1:1 ratio) who received standard of care treatment. We measured at enrollment and at 3 months: a) perfused boundary region (PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity (Sideview Darkfield Imaging); higer PBR values reflect reduced thickness of endothelial glycocalyx layer b) carotid-femoral pulse wave velocity (PWV- Complior SP ALAM), c) systolic blood pressure (SBP) and d) Left Ventricular Global Longitudinal Strain (LV GLS) and by echocardiography, as indicators of myocardial performance. Results We totally assigned (n=80) participants , aged 56±9 years, 61/80 (76.25%) were males, of which (n=40) received dapagliflozin and (n=40) served as controls. 32/80 (40%) were smokers, 28/80 (35%) had hyperlipidemia and 40/80 (50%) hypertension. The baseline PBR4-25 , PWV, SBP , LV GLS and LVEF did not differ between the two groups (p>0.05). At 3-month follow-up assessment participants in the dapagliflozin arm displayed a greater improvement of PBR4-25, PWV and LVGLS compared to the control group (for PBR4-25: -8.40% vs 7.92% respectively, p=0.010; for PWV: -6.10% vs 12.30% respectively, p=0.004; for LV GLS: 9.90% vs -1.85% respectively, p=0.006) (Table). The percentage change of PWV was associated the percentage change of LV GLS (r=-0.581, p=0.001). No significant differences were observed in the change of SBP and LV EF between the two groups (p>0.05). Conclusion STEMI patients without diabetes treated with dapagliflozin for 3 months show marked improvement of arterial stiffness, endothelial glycocalyx integrity and myocardial performance.