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Dapagliflozin Influences Ventricular Hemodynamics and Exercise-Induced Pulmonary Hypertension in Type 2 Diabetes

Hiroyuki Kayano1, Shinji Koba1, Tsutomu Hirano2

  • 1Department of Medicine, Division of Cardiology, Showa University School of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 14, 2020
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitor (SGLT2-i) therapy, specifically dapagliflozin, improved cardiac function during exercise in type 2 diabetes mellitus patients. This treatment reduced right ventricular systolic pressure and left ventricular filling pressure, suggesting benefits for heart failure.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (T2DM) is associated with cardiovascular complications, including impaired cardiac function.
  • Left ventricular filling pressure (LVFP) and right ventricular systolic pressure (RVSP) can elevate during exercise in T2DM patients.
  • Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are a class of antidiabetic drugs with potential cardioprotective effects.

Purpose of the Study:

  • To evaluate the effect of SGLT2-i on left ventricular (LV) pump function during exercise in T2DM patients.
  • To determine if SGLT2-i suppresses the elevation of LV filling pressure (LVFP) and right ventricular systolic pressure (RVSP) during exercise.
  • To assess the impact of dapagliflozin on cardiac hemodynamics and blood pressure in T2DM.

Main Methods:

  • A prospective, randomized, multicenter, open-label trial involving 78 T2DM patients with poor glycemic control.
  • Patients were assigned to receive dapagliflozin (D-group) or conventional therapy (C-group).
  • Echocardiography at rest and during exercise, blood pressure monitoring, and blood tests were performed at baseline and follow-up.

Main Results:

  • Dapagliflozin significantly reduced RVSP and LVFP during exercise compared to baseline (P<0.001).
  • No significant changes in RVSP or LVFP were observed in the conventional therapy group.
  • Stroke volume index and cardiac index did not improve in either group, but blood pressure decreased in the D-group.

Conclusions:

  • Dapagliflozin significantly improves exercise-induced RVSP and LVFP in T2DM patients.
  • These findings suggest SGLT2-i therapy may have beneficial effects on heart failure in T2DM.
  • Further research is warranted to explore the long-term cardiovascular benefits of SGLT2-i in this population.
Keywords:
Cardiac functionDapagliflozinEchocardiographyExercise

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