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Effect of dapagliflozin on ventricular repolarization in patients with heart failure with reduced ejection fraction

Masaaki Nakase1, Kazuyuki Yahagi2, Yu Horiuchi1

  • 1Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo, 101-8643, Japan.

Heart and Vessels
|September 12, 2023
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2is), like dapagliflozin, may reduce ventricular arrhythmias in heart failure patients. This study found dapagliflozin significantly decreased ventricular repolarization heterogeneity after one year in heart failure with reduced ejection fraction (HFrEF) patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Electrophysiology

Background:

  • The role of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in reducing ventricular arrhythmias and sudden cardiac death remains debated.
  • Ventricular repolarization heterogeneity is a known risk factor for ventricular arrhythmias.
  • The impact of SGLT2is on ventricular repolarization in patients with heart failure with reduced ejection fraction (HFrEF) requires further investigation.

Purpose of the Study:

  • To prospectively evaluate the effect of dapagliflozin on ventricular repolarization parameters in patients with HFrEF.
  • To assess changes in QT interval, corrected QT interval (QTc), QT dispersion (QTD), corrected QTD (QTcD), T peak to T end (TpTe), and their ratios over one year.

Main Methods:

  • A prospective study involving 31 HFrEF patients in sinus rhythm newly initiated on dapagliflozin 10 mg/day.
  • Electrocardiographic parameters including QT interval, QTc, QTD, QTcD, TpTe, TpTe/QT ratio, and TpTe/QTc ratio were measured at baseline and after one year of treatment.
  • Statistical analysis was performed to determine significant changes in these parameters.

Main Results:

  • Significant reductions were observed in QT interval (427.6 ± 52.6 ms vs. 415.4 ± 35.1 ms; p=0.047), QTc interval (437.1 ± 37.3 ms vs. 425.6 ± 22.7 ms; p=0.019), QTD (54.1 ± 11.8 ms vs. 47.6 ± 14.7 ms; p=0.003), QTcD (56.0 ± 11.2 ms vs. 49.4 ± 12.3 ms; p=0.004), and TpTe (98.0 ± 15.6 ms vs. 85.5 ± 20.9 ms; p=0.018) after one year.
  • The TpTe/QTc ratio also decreased significantly (0.225 ± 0.035 vs. 0.202 ± 0.051; p=0.044).
  • No significant change was noted in the TpTe/QT ratio (0.231 ± 0.040 vs. 0.208 ± 0.054; p=0.052).

Conclusions:

  • One-year treatment with dapagliflozin significantly reduced QT interval, QT dispersion, and TpTe in HFrEF patients.
  • These findings suggest that dapagliflozin may exert beneficial effects by reducing ventricular repolarization heterogeneity.
  • This reduction in heterogeneity could potentially contribute to the suppression of ventricular arrhythmias in this patient population.
Keywords:
Heart failure with reduced ejection fractionQT dispersionSodium–glucose cotransporter-2 inhibitorsSudden cardiac deathVentricular repolarization

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