Impact And Related Factors Of Dapaglifozin On Left Ventricular Diastolic Function Of Patients With Type 2 Diabetic Mellitus With Chronic Diastolic Heart Failure

Background and ObjectiveType 2 diabetes mellitus(T2DM)is one of the major risk factors for heart failure(HF).There is a high incidence of heart failure with mid-range ejection fraction(HFmrEF)and heart failure with preserved ejection fraction(HFpEF)in patients with T2DM[1,2]The life of T2DM patients is significantly extended,with the development of society and economy,leading to an increased incidence of heart failure.Traditional glucose-lowering drugs only reduce blood glucose level and improve T2DM microvascular complications,but with limited impact on macrovascular complications,and even some traditional glucose-lowering drugs(such as thiazolidinediones)can increase HF risk.It is extremely important to select hypoglycemic drugs accurately that have no effect on,or even can reduce the risk of HF for patients with T2DM combined with HF,in addition to the drugs recommended by the guidelines for the treatment of HF.Sodium glucose cotransporter type 2(SGLT2)inhibitor is a novel hypoglycemic agent for the treatment of T2DM with cardiovascular protection.Related studies have shown that dapagliflozin can significantly reduce the incidence of HF and cardiovascular related death[3]Other studies[4]have found that left ventricular diastolic function is closely related to HFpEF and HFmrEF,and left ventricular diastolic dysfunction is considered to be an important predictor of the prognosis of patients with heart failure with decreased ejection fraction(HFrEF).At present,the effect of SGLT2 inhibitors on left ventricular diastolic function in T2DM patients with HF is still unclear.Forty-one T2DM patients with HF which treated with dapagliflozin were selected in this research.Clinical data of the T2DM patients with HF were collected before and after medication,to investigate the effects and related factors of dapagliflozin on left ventricular diastolic function.Object and MethodsA prospective cohort trial was conducted from September 2017 to May 2019 among T2DM patients with HF who treatment in the second affiliated hospital of zhengzhou university and treated with dapagliflozin.A total of forty-one T2DM patients with HF were enrolled in this study.The clinical data were performed at baseline and 6 months after administration of dapagliflozin.The change of body weight,blood pressure,heart rate,hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),velocities of early diastolic filling wave(E),early diastolic velocity of the mitral annulus(e'),E/e',left ventricular mass index(LVMI),left atrial volume index(LAVI)and left ventricular ejection fraction(LVEF)were measured at baseline and 6 months after treatment.The patients were divided into improved group and unimproved group by using E/e,and e' as criteria for diastolic dysfunction:E/e'<8 with concomitant e'>8 is considered as normal;E/e'<8 with concomitant e'<8 is considered as left ventricular diastolic dysfunction(grade ?);8<E/e'<15 is considered as left ventricular diastolic dysfunction(grade ?);E/e'>15 is considered as left ventricular diastolic.dysfunction(grade ?).Improved group is patients whose left ventricular diastolic dysfunction reduced more than one grade after treatment,and unimproved group is patients whose left ventricular diastolic dysfunction is unchanged or increased after treatment.This study obtained approval from the institutional.review board of The Second Affiliated Hospital of Zhengzhou University.All patients signed their consent in this study.Results(1)A total of forty-one T2DM patients with HF were enrolled and completed the trial in this study.Compared with baseline,e' increased from(5.86±1.26)to(6.47±1.45)cm/s.E/e',LAVI,and LVMI significantly decreased from(11.39±2.91)to(10.38±2.16),from(30.78±4.19)to(29.00±4.57)ml/m2,and from(80.39±18.89)to(76.75±19.22)g/m2,LVEF from 56(47?61)%to 58(48?65)%,6 months after administration of dapaglifozin(P<0.05).(2)Compared with baseline,body weight decreased from 68.1(63.0?72.5)to 66.3(60.4?75.8)kg,BMI decreased from 24.5(22.7?26.1)to 24.1(22.2?25.7)kg/m2,HbA1c decreased from 7.3(7.2?7.7)%to 7.2(7.0?7.3)%,6 months after administration of dapaglifozin(P<0.05).(3)Univariate analysis showed that overweight/obesity BMI(x2=9.926,P=0.006),with hypertension(x2=6.069,P=0.013)are related factors for improvement of left ventricular diastolic function in T2DM patients with HF after treatment of dapagliflozin.Multivariate analysis showed that with hypertension(OR=11.362,95%CI:4.173?63.429,P=0.001)is independent related factor for the improvement of left ventricular diastolic function in T2DM patients with HF after treatment of dapagliflozin.Conclusions(1)Dapagliflozinon can improve left ventricular diastolic function in T2DM patients with HF.(2)BMI,with hypertension are related factors for improvement of left ventricular diastolic function in T2DM patients with HF after treatment of dapagliflozin.(3)With hypertension is independent related factor for improvement of left ventricular diastolic function in T2DM patients with HF after treatment of dapagliflozin.