Empagliflozin and left atrial function in patients with type 2 diabetes mellitus and coronary artery disease: insight from the EMPA-HEART CardioLink-6 randomized clinical trial.

Yin Ge, Djeven P Deva, Kim A Connelly, C David Mazer, Adrian Quan, Andrew T Yan, Shaun G Goodman, Hwee Teoh, Subodh Verma, Archana Rai, Marina Pourafkari, Ming Yen Ng, Piero Triverio, Laura Jiminez-Juan

Journal: Cardiovascular diabetology 2024;23(1):319

PMID: 39198860

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Abstract

BACKGROUND

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated reduction in heart failure outcomes in patients with type 2 diabetes mellitus, although the exact mechanism of benefit remains unclear. Alteration in left atrial (LA) function due to chronic pressure or volume overload is a hallmark of heart failure.

OBJECTIVE

To evaluate the effect of the SGLT2 inhibitor empagliflozin on LA volume and function.

METHODS

90 patients with coronary artery disease and type 2 diabetes (T2DM) were randomized to empagliflozin (n = 44) or placebo (n = 46), and underwent cardiac magnetic resonance (CMR) imaging at baseline and after 6 months. The main outcome was change in LA volume; LA function, including active and passive components, was also measured by a blinded reader.

RESULTS

At baseline, there was no significant difference in LA volumes between the empagliflozin (indexed maximum LA volume 26.4 ± 8.4mL/m, minimum LA volume 11.1 ± 5.7mL/m) and placebo (indexed maximum LA volume 28.7 ± 8.2mL/m, minimum LA volume 12.6 ± 5.0mL/m) groups. After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m (95% CI: -1.7 to 3.7 mL/m; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m (95% CI: -0.9 to 2.6 mL/m; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59).

CONCLUSION

SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes [EMPA-HEART]; NCT02998970).

Address: Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada.; Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. [email protected].; University of Toronto, Toronto, Canada. [email protected].; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada. [email protected].; University of Toronto, Toronto, Canada.; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.; Division of Cardiac Surgery, St Michael's Hospital, Toronto, Canada.; University of Toronto, Toronto, Canada.; Department of Anesthesia, St Michael's Hospital, Toronto, Canada.; Division of Cardiac Surgery, St Michael's Hospital, Toronto, Canada.; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Canada.; Division of Cardiac Surgery, St Michael's Hospital, Toronto, Canada.; Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.; University of Toronto, Toronto, Canada.; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.; Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada.; University of Toronto, Toronto, Canada.; Department of Electrical & Computer Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada. [email protected].; Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. [email protected].; University of Toronto, Toronto, Canada. [email protected].; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada. [email protected].; Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. [email protected].; University of Toronto, Toronto, Canada. [email protected].

DOI: 10.1186/s12933-024-02344-6

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MeSH Terms: Humans, Glucosides, Benzhydryl Compounds, Diabetes Mellitus, Type 2, Sodium-Glucose Transporter 2 Inhibitors, Male, Coronary Artery Disease, Female, Middle Aged, Aged, Atrial Function, Left, Treatment Outcome, Time Factors, Double-Blind Method, Atrial Remodeling, Heart Atria