DOCUMENT
1/1
Empagliflozin Treatment is Associated With Improvements in Cardiac Energetics and Function and Reductions in Myocardial Cellular Volume in Patients With Type 2 Diabetes
figure
posted on 2021-10-05, 21:44 authored by Sharmaine Thirunavukarasu, Nicholas Jex, Amrit Chowdhary, Imtiaz Ul Hassan, Sam Straw, T.P. Craven, M Gorecka, David Broadbent, Peter Swoboda, Klaus K Witte, Richard M Cubbon, Hui Xue, Peter Kellman, John P. Greenwood, Sven Plein, Eylem LeveltSodium–glucose-cotransporter-2
(SGLT2) inhibitors reduce the risk of major
adverse CV events and hospitalization for heart failure in type 2 diabetes
(T2D) patients. Utilising cardiovascular
magnetic resonance imaging (CMR) and 31phosphorus magnetic resonance
spectroscopy(31P-MRS) in a longitudinal cohort study, we aimed to
investigate the effects of the selective SGLT2i empagliflozin on myocardial
energetics, cellular volume, function and perfusion. Eighteen T2D
patients underwent CMR and 31P-MRS scans before and after
twelve-week empagliflozin treatment. Plasma N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) levels were measured. Ten
volunteers with normal glycaemic control underwent an identical scan protocol on a single visit. Empagliflozin treatment was associated with significant
improvements in PCr/ATP ratio (1.52 to 1.76, p=0.009). This was accompanied by
a 7% absolute increase in the mean LVEF (p=0.001), 3% absolute increase in the mean global longitudinal strain (p=0.01),
8 ml/m2 absolute reduction in the mean myocardial cell volume (p=0.04) and
61% relative reduction in the mean NT-proBNP (p=0.05)
from baseline measurements. No significant change in myocardial blood flow or
diastolic strain was detected. Empagliflozin thus ameliorates the ‘cardiac energy-deficient’
state, regresses adverse myocardial cellular remodelling, and improves cardiac function, offering therapeutic opportunities to prevent or modulate heart failure
in T2D.