Abstract 14114: Sodium-glucose Cotransporter-2 Inhibitors Benefit Cardiac Diastolic Function

Introduction: Sodium-glucose Cotransporter-2 (SGLT-2) inhibitors are drugs with profound interest because of their beneficial effect on multiple organ systems, including the cardiovascular and renal systems. Their interplay with these systems could prove beneficial in managing complex conditions like heart failure with preserved ejection fraction. We sought to compare cardiac diastolic function in patients on SGLT-2 inhibitors with those on metformin. Methods: Data were collected retrospectively after approval from our institutional review board. The study group included patients on SGLT-2 inhibitors (n=75), and the control group had patients on metformin (n=82), primarily for diabetes mellitus. Patients with ejection fraction less than 50% were excluded from the study. Data collected included age, systolic blood pressure (SBP), left ventricular (LV) ejection fraction, LV and left atrial dimensions, and diastolic parameters. Mean values, along with standard deviation, were calculated. Multivariate regression analysis for diastolic function was performed while adjusting for confounders, including age, body mass index, and SBP. Results: Study group showed better diastolic function as evidenced by significantly higher e’ medial (6.8 v/s 6.16 cm/s; p = 0.03) and e’ lateral (9.8 v/s 7.9 cm/s; p=0.008) when compared to the control group. E/e’, a marker of pulmonary capillary wedge pressure, was lower in the study group (12.87 v/s 14.36; p=0.08); however, it did not reach statistical significance. LA volume index was significantly lower in the study group, suggestive of favorable hemodynamic status (26.5 v/s 29.6 mL/m 2 ; p=0.03). SBP was significantly lower in the study group (127 v/s 135 mm Hg; p=0.01). Multivariate regression model demonstrated SBP as a significant confounder that contributed to e’ (average) difference between the two groups. Conclusions: SGLT-2 inhibitors favored better diastolic measurements when compared with metformin alone. The mechanism may be attributed to its BP-lowering effect. A larger prospective study is required to determine the role of SGLT-2 inhibitors.

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P2598Left atrial mechanics in patients with acute pulmonary edema and preserved ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0923 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A E Vijiiac ◽

C Acatrinei ◽

C Neagu ◽

S Onciul ◽

D Zamfir ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Pulmonary Edema ◽

Left Ventricular ◽

Acute Pulmonary Edema ◽

Control Group ◽

Study Group ◽

Filling Fraction ◽

Ejection Force ◽

Booster Pump

Abstract Background The left atrium (LA) is a highly dynamic chamber that has 3 mechanical functions (reservoir, conduit, booster pump), as well as additional endocrine and regulatory properties. It is a marker of both the severity and chronicity of diastolic dysfunction and its remodelling has been shown to be a reliable predictor of clinical outcome in patients with heart disease. While LA function has been extensively studied in chronic heart failure, information about LA mechanics in patients with acute heart failure and preserved left ventricular ejection fraction (EF) are scarce. Purpose We sought to assess LA mechanics in a cohort of patients with acute pulmonary edema and preserved EF and compare it with a normal reference group. Methods We included 50 consecutive patients (22 men) with acute pulmonary edema, preserved EF and sinus rhythm in our study. Patients with significant mitral or aortic valve disease were not considered eligible. The control group consisted of 30 subjects (18 men) with no previous cardiovascular disease. We performed conventional transthoracic echocardiography for all patients and we assessed various parameters of LA mechanics. To evaluate the reservoir function, we determined the total ejection volume (EV), the total EF, the LA expansion index (LAEI) and the LA function index (LAFI). To evaluate the conduit function, we determined the passive EV and passive EF. For the booster pump function, we determined the active EV, active EF, the atrial filling fraction, the ejection force and the LA kinetic energy (LAKE). We used T-test to compare the parameters between the two groups. Results The mean age in the study group was 72±14 years, while in the control group the mean age was 56±16 years (p=0.06). The total EV did not differ significantly between groups (p=0.44). The total LA ejection fraction was lower in the study group: 29±10% vs. 51±9% (p<0.001), as well as the LAEI (45.1±24.6 vs. 110.9±32.1, p<0.001) and the LAFI (0.17±0.12 vs. 0.58±0.20, p<0.001). Among parameters assessing LA conduit function, there were no differences in passive EV (p=0.64), but passive LA ejection fraction was significantly lower in the study group: 15±7% vs. 28±11%, p=0.003. The same trend was noted for active LA ejection fraction (16±10% vs. 31±13%, p=0.005). The ejection force was impaired in the study group: 39.1±30.6 kdynes vs. 15.2±12.3 kdynes, p<0.001. Other parameters evaluating LA booster pump function did not differ significantly between groups (p=0.12 for atrial filling fraction, p=0.74 for LAKE). Conclusion All three integrated phases of left atrial mechanics (reservoir, conduit, booster pump) are impaired in patients with acute pulmonary edema and preserved left ventricular EF. These findings highlight the importance of diastolic dysfunction in the pathogenesis of acute heart failure for these patients and they suggest that LA dysfunction might be a potential therapeutic target in this clinical setting. Acknowledgement/Funding This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF

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The effect of spironolactone on diastolic function in haemodialysis patients

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02176-5 ◽

2021 ◽

Author(s):

T. Hauser ◽

◽

V. Dornberger ◽

U. Malzahn ◽

S. J. Grebe ◽

...

Keyword(s):

Ejection Fraction ◽

Diastolic Function ◽

Left Atrial Volume ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Left Atrial Volume Index ◽

Maintenance Haemodialysis ◽

Significant Difference

AbstractHeart failure with preserved ejection fraction (HFpEF) is highly prevalent in patients on maintenance haemodialysis (HD) and lacks effective treatment. We investigated the effect of spironolactone on cardiac structure and function with a specific focus on diastolic function parameters. The MiREnDa trial examined the effect of 50 mg spironolactone once daily versus placebo on left ventricular mass index (LVMi) among 97 HD patients during 40 weeks of treatment. In this echocardiographic substudy, diastolic function was assessed using predefined structural and functional parameters including E/e’. Changes in the frequency of HFpEF were analysed using the comprehensive ‘HFA-PEFF score’. Complete echocardiographic assessment was available in 65 individuals (59.5 ± 13.0 years, 21.5% female) with preserved left ventricular ejection fraction (LVEF > 50%). At baseline, mean E/e’ was 15.2 ± 7.8 and 37 (56.9%) patients fulfilled the criteria of HFpEF according to the HFA-PEFF score. There was no significant difference in mean change of E/e’ between the spironolactone group and the placebo group (+ 0.93 ± 5.39 vs. + 1.52 ± 5.94, p = 0.68) or in mean change of left atrial volume index (LAVi) (1.9 ± 12.3 ml/m2 vs. 1.7 ± 14.1 ml/m2, p = 0.89). Furthermore, spironolactone had no significant effect on mean change in LVMi (+ 0.8 ± 14.2 g/m2 vs. + 2.7 ± 15.9 g/m2; p = 0.72) or NT-proBNP (p = 0.96). Treatment with spironolactone did not alter HFA-PEFF score class compared with placebo (p = 0.63). Treatment with 50 mg of spironolactone for 40 weeks had no significant effect on diastolic function parameters in HD patients.The trial has been registered at clinicaltrials.gov (NCT01691053; first posted Sep. 24, 2012).

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A Vegan Athlete’s Heart—Is It Different? Morphology and Function in Echocardiography

Diagnostics ◽

10.3390/diagnostics10070477 ◽

2020 ◽

Vol 10 (7) ◽

pp. 477

Author(s):

Wojciech Król ◽

Szymon Price ◽

Daniel Śliż ◽

Damian Parol ◽

Marcin Konopka ◽

...

Keyword(s):

Diastolic Function ◽

Left Ventricular Mass ◽

Systolic Function ◽

Left Ventricular ◽

Control Group ◽

Study Group ◽

Similar Frequency ◽

Ventricular Mass ◽

Vegan Group ◽

And Function

Plant-based diets are a growing trend, including among athletes. This study compares the differences in physical performance and heart morphology and function between vegan and omnivorous amateur runners. A study group and a matched control group were recruited comprising N = 30 participants each. Eight members of the study group were excluded, leaving N = 22 participants. Members of both groups were of similar age and trained with similar frequency and intensity. Vegans displayed a higher VO2max (54.08 vs. 50.10 mL/kg/min, p < 0.05), which correlated positively with carbohydrate intake (ρ = 0.52) and negatively with MUFA (monounsaturated fatty acids) intake (ρ = −0.43). The vegans presented a more eccentric form of remodelling with greater left ventricular end diastolic diameter (LVEDd, 2.93 vs. 2.81 cm/m2, p = 0.04) and a lower relative wall thickness (RWT, 0.39 vs. 0.42, p = 0.04) and left ventricular mass (LVM, 190 vs. 210 g, p = 0.01). The left ventricular mass index (LVMI) was similar (108 vs. 115 g/m2, p = NS). Longitudinal strain was higher in the vegan group (−20.5 vs. −19.6%, p = 0.04), suggesting better systolic function. Higher E-wave velocities (87 vs. 78 cm/s, p = 0.001) and E/e′ ratios (6.32 vs. 5.6, p = 0.03) may suggest better diastolic function in the vegan group. The results demonstrate that following a plant-based diet does not impair amateur athletes’ performance and influences both morphological and functional heart remodelling. The lower RWT and better LV systolic and diastolic function are most likely positive echocardiographic findings.

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105 Impact of global left ventricular afterload and transaortic gradient on myocardial work in patients with aortic stenosis and preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.024 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Ilardi ◽

R E Dulgheru ◽

S Marchetta ◽

S Cimino ◽

M Cicenia ◽

...

Keyword(s):

Ejection Fraction ◽

Stroke Volume ◽

Speckle Tracking ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Low Flow ◽

Volume Index ◽

Control Group ◽

Aortic Valve Area ◽

Global Work

Abstract Funding Acknowledgements Dr. Ilardi is supported by a research grant from Cardiopath PhD program. Background Myocardial work (MW) is a new parameter that derives from myocardial strain and provides an incremental value to myocardial function, incorporating measurement of deformation and load. To date, little is known about the changes in MW related to AS severity and arterial compliance. Purpose We investigated the effect of severity of AS, valvulo-arterial impedance (Zva) and stroke volume in patients with AS and preserved LV ejection fraction (EF). Methods 283 patients (60% males, mean age 71 ± 12 years old) with varying grades of AS and LVEF≥50% were enrolled. Exclusion criteria were more than mild associated cardiac valve lesion, left bundle branch block, and suboptimal quality of speckle-tracking image analysis. The control group included 50 patients matched for age and sex. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Results Patients with AS had higher systolic (p = 0.017) and diastolic arterial pressure (p = 0.007), increased LV wall thickness, mass index (p < 0.001) and volumes (p = 0.045) compared to controls. Greater indexed left atrial volume, E/e’ and trans-tricuspid gradient were also observed in the AS group (p < 0.001). As expected, speckle tracking analysis revealed significant lower GLS in AS than in control group (18.7 ± 3.2 vs 20.7 ± 2.1%, p < 0.001). Conversely, increased values of GCW and GWI (respectively 2965 ± 647 vs 2360 ± 353 mmHg%, and 2535 ± 559 vs 2005 ± 302 mmHg%, p < 0.001) were observed in patients with AS. Besides, GWW was significantly increased in AS vs controls (147 ± 108 vs 90 ± 49 mmHg%, p = 0.001), with no changes in terms of GWE (95 ± 4 vs 96 ± 2%, p = 0.110). When patients were stratified according to the AS severity, the analysis of variance revealed that GCW, GWI and GWW significantly increased with higher transaortic mean gradient and lower aortic valve area (p < 0.001). Also Zva demonstrated to impact on CGW (p = 0.040) and GWW (p < 0.001), with increased values in presence of increased global LV afterload (Zva > 4.5 mmHg/ml/m2). Conversely, patients with low-flow AS (stroke volume index < 35 ml/m2) showed lowers values of GCW (p = 0.014) and GWI (p = 0.001) compared to normal flow AS, but increased GWW (p = 0.041) and reduced GWE (93 ± 7 vs 95 ± 4%, p = 0.010). At multivariable analysis, mean gradient (p < 0.001), Zva (p = 0.038), systolic blood pressure (p < 0.001) and GLS (p < 0.001) were independently associated with GWI and GCW, while only GLS was associated with GWW. Conclusion In patients with AS and preserved LVEF, GLS reduction is accompanied by an increase of GCW, GWI and GWW, without affecting the GWE. These MW modifications seem to be mainly correlated to the severity of AS and increased global LV afterload.

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Angioaccess for hemodialysis in kidney transplantation

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.v8i1.638 ◽

2021 ◽

pp. 1-13

Author(s):

Rafael Enrique Cruz Abascal ◽

José Ignacio Ramírez Gómez ◽

Carlos Gutiérrez Gutiérrez ◽

Raunel Batista Hernández ◽

Milagro Estrella Hernández ◽

...

Keyword(s):

Kidney Transplantation ◽

Left Ventricle ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Left Heart ◽

White Skin

Cardiovascular complications represent the main cause of morbidity and mortality in patients with chronic renal disease, so the objective of this article is to demonstrate the influence of the patency of the arteriovenous fistula on echocardiographic variables measured in the left heart. For this, a multivariate study, longitudinal, prospective and controlled study of independent groups after an intervention that included 39 patients who had their angioaccess closed (study group) and 42 who were not exposed to surgery (control group). Both groups exhibited functional kidney transplantation. The main results emerge when comparing the prevalence between the study group and the control group, the average age; 45.6 and 44.1 years, the male sex, 24 (60%) and 23 (53.5%) and the white skin color; 33 (82.5%) and 32 (74.4%). The most frequent etiology of the original nephropathy was hypertensive vascular nephropathy; 12 (30%) vs 14 (32.6%). Among the clinical manifestations, remission of palpitations and dyspnea on exertion were evidenced in the study group. With regard to blood pressure, for the systolic it ranged from 123 ±13.4 to 120.5 ±9.2 vs. 125.6 ±8.4 to 128 ±8.3 mmHg (p= 0.000), while the diastolic varied from; 76.8 ±7.5 to 76.3 ±6.2 vs. 78.6 ±4.9 to 82.4 ±3.9 mmHg (p= 0.000). The hematocrit had equivalent values; 0.43 ±0.06 and 0.45 ±0.06 vs 0.42 ±0.05 and 0.42 ±0.06 l/l (p= 0.035) and the serum creatinine showed decrease in the operated patients from; 106.8 ±26.2 to 99.8 ±23.9 μMol/l vs 114 ±27.8 to 120.3 ±31 μMol/l (p= 0.002). The echocardiographic variables measured comparatively according to the location of the angioaccesses at the left elbow level; diameter of the left ventricle: 3.12 ±4.08 vs 1.48 ±3.46 mms (p=0.001), ejection fraction of the left ventricle: 2.99 ±5.47 vs -1.98 ±6.23 % (p=0.018) and the telediasolic volume: -23 ±33.41 vs 10.86 ±36.87 ml (p=0.006). The contralateral elbow revealed; for the left ventricular ejection fraction: 3.32 ±3.42 vs -2.18 ±4.78 % (p=0.037) and for cardiac output: -1.29 ±0.88 vs -0.26 ±0.86 l/min (0.020). The conclusions show that the our study has shown that closing the angioaccess to patients with functioning renal transplants with respect to those not operated, contributes to the regression of morphological and hemodynamic alterations observed by transthoracic echocardiography in the left heart at the different locations of the vascular accesses.

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New expectations for diastolic function assessment in transthoracic echocardiography based on a semi-automated computing of strain–volume loops

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa123 ◽

2020 ◽

Vol 21 (12) ◽

pp. 1366-1371 ◽

Cited By ~ 1

Author(s):

Arnaud Hubert ◽

Virginie Le Rolle ◽

Elena Galli ◽

Auriane Bidaud ◽

Alfredo Hernandez ◽

...

Keyword(s):

Ejection Fraction ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Automated Method ◽

Significant Difference ◽

Function Assessment

Abstract Aims Early diagnosis of heart failure with preserved ejection fraction (HFpEF) by determination of diastolic dysfunction is challenging. Strain–volume loop (SVL) is a new tool to analyse left ventricular function. We propose a new semi-automated method to calculate SVL area and explore the added value of this index for diastolic function assessment. Method and results Fifty patients (25 amyloidosis, 25 HFpEF) were included in the study and compared with 25 healthy control subjects. Left ventricular ejection fraction was preserved and similar between groups. Classical indices of diastolic function were pathological in HFpEF and amyloidosis groups with greater left atrial volume index, greater mitral average E/e’ ratio, faster tricuspid regurgitation (P < 0.0001 compared with controls). SVL analysis demonstrated a significant difference of the global area between groups, with the smaller area in amyloidosis group, the greater in controls and a mid-range value in HFpEF group (37 vs. 120 vs. 72 mL.%, respectively, P < 0.0001). Applying a linear discriminant analysis (LDA) classifier, results show a mean area under the curve of 0.91 for the comparison between HFpEF and amyloidosis groups. Conclusion SVLs area is efficient to identify patients with a diastolic dysfunction. This new semi-automated tool is very promising for future development of automated diagnosis with machine-learning algorithms.

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Abstract 12897: Coenzyme Q10 in the Treatment of Heart Failure With Preserved Ejection Fraction: A Prospective, Randomized, Double-blind Trial

Circulation ◽

10.1161/circ.142.suppl_3.12897 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tal Y Samuel ◽

Tal Hasin ◽

Israel Gotsman ◽

Tanya Weitsman ◽

Fanny Ben Ivgi ◽

...

Keyword(s):

Heart Failure ◽

Placebo Group ◽

Ejection Fraction ◽

Diastolic Function ◽

Coenzyme Q10 ◽

The Elderly ◽

Left Ventricular ◽

Volume Index ◽

Preserved Ejection Fraction ◽

Double Blind

Background: Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in the elderly and is increasing in prevalence. No specific treatment for this condition appears to be effective. Coenzyme Q10 (CoQ10) is an essential cofactor for energy production and reduced levels have been noted in HF. Previous studies have suggested a possible role for CoQ10 in the treatment of HF in particular in the elderly. Aim: To evaluate the effect of CoQ10 supplementation on diastolic function in patients with HFpEF. Methods: A prospective, randomized, double-blind, placebo-controlled trial. Inclusion criteria were age > 50 years, New York Heart Association class II-IV, ejection fraction > 50%, and evidence of impaired diastolic function defined as lateral e' < 0.09 cm/sec, average E/e' > 13 or average E/e' > 8 with additional markers of impaired diastolic function such as delayed relaxation (E/A < 0.5), elevated left atrial volume index (> 40ml / m 2 ) elevated left ventricular mass index ( > 122 gr/ m 2 ♀ or 149 gr/ m 2 ♂) or pulmonary hypertension. Patients with other forms of cardiomyopathies or treated with chronic renal replacement therapy were excluded. Echocardiographic studies and levels of N-terminal pro-B type natriuretic peptide (NT-proBNP) were completed at baseline and following 4 months of CoQ10 (300 mg daily) or placebo supplementation. Results: A total of 39 patients were enrolled, 19 patients in the CoQ10 and 20 patients in the placebo group. Groups were similar in baseline clinical characteristics. Compliance was high and similar between groups (average 208 ± 108 mg/day for the CoQ10 versus 212 ± 95 mg/day for the placebo group). No significant effect was observed on indices of diastolic function or NT-proBNP levels following 4 months of CoQ10 use. Conclusions: Treatment with CoQ10 did not affect indices of diastolic function or NT-proBNP levels in patients with HFpEF. Our study does not support the routine use of CoQ10 in patients with HFpEF.

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Decreased hydraulic forces are incrementally associated with survival beyond conventional measures of diastolic dysfunction

10.1101/2021.12.22.21268283 ◽

2021 ◽

Author(s):

Dhnanjay Soundappan ◽

Angus Seen Yeung Fung ◽

Daniel E Loewenstein ◽

David Playford ◽

Geoff Strange ◽

...

Keyword(s):

Ejection Fraction ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Left Atrial Volume ◽

Left Ventricular ◽

Volume Index ◽

Cross Sectional ◽

Left Atrial Volume Index ◽

C Statistic ◽

Area Difference

BACKGROUND: Decreased hydraulic forces during diastole contribute to reduced left ventricular (LV) filling and heart failure with preserved ejection fraction. OBJECTIVES: To determine the association between diastolic hydraulic forces, estimated by atrioventricular area difference (AVAD), and both diastolic function and survival. We hypothesized that decreased diastolic hydraulic forces, estimated as AVAD, would associate with survival independent of conventional diastolic dysfunction measures. METHODS: Patients (n=11,734, median [interquartile range] 3.9 [2.4-5.0] years follow-up, 1,213 events) were selected from the National Echo Database Australia based on the presence of relevant transthoracic echocardiographic measures, LV ejection fraction (LVEF) ≥ 50%, heart rate 50-100 beats/minute, the absence of moderate or severe valvular disease, and no prior cardiac surgery. AVAD was calculated as the cross-sectional area difference between the LV and left atrium. LV diastolic dysfunction was graded according to 2016 guidelines. RESULTS: AVAD was weakly associated with E/e prime, left atrial volume index, and LVEF (multivariable global R2=0.15, p<0.001), and not associated with e prime and peak tricuspid regurgitation velocity. Decreased AVAD was independently associated with poorer survival, and demonstrated improved model discrimination after adjustment for diastolic function grading (C-statistic 0.645 vs 0.607) and E/e prime (C-statistic 0.639 vs 0.621), respectively. CONCLUSIONS: Decreased hydraulic forces, estimated by AVAD, are weakly associated with diastolic dysfunction and provide an incremental prognostic association with survival beyond conventional measures used to grade diastolic dysfunction.

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Left Atrial Volume Index in Diagnosis of Heart Failure With Preserved Ejection Fraction

10.21203/rs.3.rs-593762/v1 ◽

2021 ◽

Author(s):

Xingxue Pang ◽

Ruoyi Liu ◽

Li Xu ◽

Xin Tao ◽

Xuezeng Hao ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Pressure ◽

Left Atrial Volume ◽

Left Ventricular ◽

Volume Index ◽

Control Group ◽

Preserved Ejection Fraction ◽

Left Atrial Volume Index ◽

Reduced Ejection Fraction

Abstract Objective To assess the value of left atrium volume index（LAVI）for diagnosing heart failure with preserved ejection fraction (HFpEF) based on the invasive determination of left ventricular end-diastolic pressure (LVEDP).Methods A total of 710 cases of patients with dyspnea (LVEF≥50%) were enrolled in this retrospective study. Left ventricular end-diastolic pressure (LVEDP) was measured through selective coronary angiography. According to the value of LVEDP, cases were divided into the HFpEF group ( LVEDP≥15mmHg) and the control group (LVEDP<15mmHg). LAVI was calculated based on cardiac compartment diameter, as measured by echocardiography, and body surface area (BSA). Differences of LAVI between the HFpEF group and the control group, and between subgroups in the HFpEF group were analyzed.Results The difference in LAVI between the control group and the HFpEF group was statistically significant (41.35±2.28vs.46.78±2.63ml/m2, p=0.008). LVEDP was positively correlated with LAVI (Pearson: r=0.787, P＜0.001). When LAVI took the best cutoff value of 43.7 mm/m2, the sensitivity and specificity of diagnosis of HFpEF were 92.0% and 88.9%. When the boundary value of LAVI was from 41.7 to 45.7 mm/m2, the sensitivity of the diagnosis of ejection fraction retention heart failure was from 97.4% to 64.4% and the specificity was from 51.2.0% to 92.2%.Conclusion In patients with dyspnea after exclusion of heart failure with reduced ejection fraction (HFrEF), LAVI is positively correlated with LVEDP. LAVI can be used to diagnose HFpEF when HFrEF is excluded.

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Effect of sodium–glucose cotransporter 2 inhibitors on cardiac structure and function in type 2 diabetes mellitus patients with or without chronic heart failure: a meta-analysis

Cardiovascular Diabetology ◽

10.1186/s12933-020-01209-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Yi-Wen Yu ◽

Xue-Mei Zhao ◽

Yun-Hong Wang ◽

Qiong Zhou ◽

Yan Huang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Ejection Fraction ◽

Left Ventricular ◽

Volume Index ◽

Cardiac Structure ◽

Reduced Ejection Fraction ◽

Sodium Glucose Cotransporter

Abstract Background Although the benefits of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular events have been reported in patients with type 2 diabetes mellitus (T2DM) with or without heart failure (HF), the impact of SGLT2i on cardiac remodelling remains to be established. Methods We searched the PubMed, Embase, Cochrane Library and Web of Science databases up to November 16th, 2020, for randomized controlled trials reporting the effects of SGLT2i on parameters of cardiac structure, cardiac function, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level or the Kansas City Cardiomyopathy Questionnaire (KCCQ) score in T2DM patients with or without chronic HF. The effect size was expressed as the mean difference (MD) or standardized mean difference (SMD) and its 95% confidence interval (CI). Subgroup analyses were performed based on the stage A–B or stage C HF population and HF types. Results Compared to placebo or other antidiabetic drugs, SGLT2i showed no significant effects on left ventricular mass index, left ventricular end diastolic volume index, left ventricular end systolic volume index, or left atrial volume index. SGLT2i improved left ventricular ejection fraction only in the subgroup of HF patients with reduced ejection fraction (MD 3.16%, 95% CI 0.11 to 6.22, p = 0.04; I2 = 0%), and did not affect the global longitudinal strain in the overall analysis including stage A–B HF patients. SGLT2i showed benefits in the E/e’ ratio (MD − 0.45, 95% CI − 0.88 to − 0.03, p = 0.04; I2 = 0%), plasma NT-proBNP level (SMD − 0.09, 95% CI − 0.16 to − 0.03, p = 0.004; I2 = 0%), and the KCCQ score (SMD 3.12, 95% CI 0.76 to 5.47, p = 0.01; I2 = 0%) in the overall population. Conclusion The use of SGLT2i was associated with significant improvements in cardiac diastolic function, plasma NT-proBNP level, and the KCCQ score in T2DM patients with or without chronic HF, but did not significantly affect cardiac structural parameters indexed by body surface area. The LVEF level was improved only in HF patients with reduced ejection fraction.

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