SGLT-2 inhibitor dapagliflozin improves left ventricular diastolic function and reduces circulating inflammatory markers in HFpEF patients: a retrospective cohort study

This study sought to evaluate the efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitor Dapagliflozin in ameliorating left ventricular diastolic function (LVDF) and attenuating systemic inflammatory biomarkers in patients with heart failure with preserved ejection fraction (HFpEF).

A total of 114 patients diagnosed with HFpEF were retrospectively enrolled and allocated into either the SGLT-2 inhibitor group (Dapagliflozin combined with standard guideline-directed therapy; n = 58) or the Control group (standard guideline-directed therapy alone; n = 56). Echocardiographic parameters at baseline and 6-month follow-up were measured, including early diastolic transmitral flow velocity/early diastolic mitral annular velocity ratio (E/e') and left atrial volume index (LAVI). Circulating inflammatory markers comprising high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were examined. In addition, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores were collected for functional and symptomatic assessments.

After six months of treatment, the SGLT-2 inhibitor group exhibited significant improvements in cardiac diastolic parameters. E/e' ratio decreased significantly from 14.8 ± 3.2 to 12.1 ± 2.7 (P < 0.001), and LAVI decreased from 38.6 ± 8.4 to 34.2 ± 7.1 mL/m² (P = 0.003). Consistently, systemic inflammation was markedly alleviated. hs-CRP decreased from 4.82 ± 1.73 to 2.94 ± 1.28 mg/L (P < 0.001), IL-6 decreased from 8.46 ± 2.91 to 5.73 ± 2.14 pg/mL (P = 0.002), and TNF-α decreased from 12.8 ± 4.6 to 9.4 ± 3.8 pg/mL (P = 0.011). Moreover, NT-proBNP levels in the SGLT-2 inhibitor group exhibited a substantial 28.4% reduction, which was significantly greater than the 8.7% reduction observed in the Control group (P = 0.004). There was also a striking reduction in MLHFQ scores in the SGLT-2 inhibitor group (average reduction: -8.6 ± 4.2 points, P < 0.001), demonstrating significant symptomatic improvement.

SGLT-2 inhibitor Dapagliflozin effectively improved LVDF and reduced systemic inflammatory burden in patients with HFpEF. These findings support the role of Dapagliflozin as a promising disease-modifying therapeutic agent for HFpEF.