LV Reverse Remodeling Not Improved by SGLT-2 Inhibitor

The inhibition of SGLT-2 was not associated with an improvement in left ventricular (LV) reverse remodeling in patients with type 2 diabetes mellitus (T2DM), new study results suggest.

“There is no known association between diastolic function parameters as determined by transthoracic echocardiography (TTE) and SGLT-2 inhibitor therapy,” the paper authors, publishing in meeting supplement of the Journal of Cardiac Failure and presenting at the Heart Failure Society of American Scientific Meeting in Philadelphia. “We hypothesized that in patients with T2DM the use of SGLT-2 inhibitors might improve TTE diastolic function parameters including LV mass and LV mass index.”

The study was a retrospective chart analysis off 141 patients with T2DM who were prescribed SGLT-2 inhibitors in either the inpatient or outpatient setting in a single center between March 2013 and March 2018. TTE variables were evaluated at baseline and at one year following treatment. The authors used paired-t testing to explore changes brought about by SGLT-2 inhibition on TTE parameters after one year. The primary study outcome was detection of change in LV mass and LV mass index, with a secondary outcome of all-cause and heart failure admissions. The mean age of the study population was 62 years (61% female, 60.8% Hispanic).

The authors observed an increase in LV mass (185.9 grams to 201.3 grams; P=0.002) and LV mass index (94.5 to 101.7; P=0.007) in patients treated with SGLT-2 inhibitors beyond one year, but did not observe improvements in other diastolic TTE parameters. The also reported no association between all-cause and heart failure admission, or total mortality, in patients taking SGLT-2 inhibitors.

“Although SGLT-2 inhibitors have shown in the metabolic model to improve heart failure in diabetic patients, they did not show a potential role in the improvement of LV reverse remodeling,” the authors concluded. “On the contrary, our data suggests a modest increase in LV mass and LV mass index in patients with T2DM taking SGLT-2 inhibitors. Future studies with larger population size over an extended period of time are warranted to validate our results.”

Roy S, Lacoste A, Zaidi B, et al. J Card Fail. 2019;25(8):S12. Abstract 031.