Effects of 3-month dapagliflozin on left atrial function in treatment-naïve patients with type 2 diabetes mellitus: assessment using 4-dimensional echocardiography.
Effects of 3-month dapagliflozin on left atrial function in treatment-naïve patients with type 2 diabetes mellitus: assessment using 4-dimensional echocardiography.
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DOI：
10.1016/j.hjc.2023.12.002
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发表时间：
2023-12
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通讯作者：
Miao Zhang;Lanlan Sun;Xiaopeng Wu;Yunyun Qin;Mingming Lin;Xueyan Ding;Weiwei Zhu;Zhe Jiang;Shan Jin;Chenlei Leng;Jiangtao Wang;Xiuzhang Lv;Qizhe Cai
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作者：
Miao Zhang;Lanlan Sun;Xiaopeng Wu;Yunyun Qin;Mingming Lin;Xueyan Ding;Weiwei Zhu;Zhe Jiang;Shan Jin;Chenlei Leng;Jiangtao Wang;Xiuzhang Lv;Qizhe Cai
背景钠-葡萄糖转运蛋白-2（SGLT-2）抑制剂达格列净可改善2型糖尿病（T2 DM）患者的左心室功能。然而，对初治T2 DM患者左心房（LA）功能的影响尚不清楚。我们研究的目的是1）使用4维自动LA定量研究达格列净治疗3个月对初治T2 DM患者LA功能的影响方法应用4D Auto LAQ评价左心房容积，基线、随访和健康对照（HC）初治T2 DM患者的纵向和周向应变。稀疏典型相关分析（sCCA）进行捕获的临床和LA超声心动图变量的变化之间的关联协变模式治疗初治T2 DM patient group.ResultsThis研究最终包括61治疗初治T2 DM患者无心血管疾病和39名健康对照（HC）。与HC相比，初治T2 DM患者在基线时显示左心房储血囊和管道功能降低，与年龄、性别、BMI和血压无关（LASr：21.11 ± 5.39 vs. 27.08 ± 5.31%，p调整= 0.017; LAScd：−11.51 ± 4.48 vs. −16.74 ± 4.51%，p调整= 0.013）。达格列净治疗3个月后，T2 DM患者左心房储血器和导管功能显著改善，与BMI和血压变化无关（LASr：21.11 ± 5.39 vs. 23.84 ± 5.74%，p调整< 0.001; LAScd：−11.51 ± 4.48 vs. −12.75 ± 4.70%，p调整< 0.001）。临床和左心房超声心动图参数显示出显着的协变（r= 0.562，p = 0.039）。在临床数据集中，心率、胰岛素和BMI的变化与LA超声心动图变量最相关。在LA超声心动图数据集，LAScd，LASr，LASr_c的变化是最相关的临床variable.ConclusionCompared HC，治疗初治T2 DM患者具有较低的LA功能，这些患者受益于达格列净管理，特别是在LA功能。
BackgroundThe sodium-glucose transporter-2 (SGLT-2) inhibitor dapagliflozin can improve left ventricular (LV) performance in patients with type 2 diabetes mellitus (T2DM). However, the effects on left atrial (LA) function in treatment-naïve T2DM patients remain unclear. The aim of our study was 1) to investigate the effects of 3-month treatment with dapagliflozin on LA function in treatment-naïve patients with T2DM using 4-dimensional automated LA quantification (4D Auto LAQ) and 2) to explore linked covariation patterns of changes in clinical and LA echocardiographic variables.Methods4D Auto LAQ was used to evaluate LA volumes, longitudinal and circumferential strains in treatment-naïve T2DM patients at baseline, at follow-up, and in healthy control (HC). Sparse canonical correlation analysis (sCCA) was performed to capture the linked covariation patterns between changes in clinical and LA echocardiographic variables within the treatment-naïve T2DM patient group.ResultsThis study finally included 61 treatment-naïve patients with T2DM without cardiovascular disease and 39 healthy controls (HC). Treatment-naïve T2DM patients showed reduced LA reservoir and conduit function at baseline compared to HC, independent of age, sex, BMI, and blood pressure (LASr: 21.11 ± 5.39 vs. 27.08 ± 5.31 %,padjusted= 0.017; LAScd: −11.51 ± 4.48 vs. −16.74 ± 4.51 %,padjusted= 0.013). After 3-month treatment with dapagliflozin, T2DM patients had significant improvements in LA reservoir and conduit function independent of BMI and blood pressure changes (LASr: 21.11 ± 5.39 vs. 23.84 ± 5.74 %,padjusted< 0.001; LAScd: −11.51 ± 4.48 vs. −12.75 ± 4.70 %,padjusted< 0.001). The clinical and LA echocardiographic parameters showed significant covariation (r= 0.562,p= 0.039). In the clinical dataset, changes in heart rate, insulin, and BMI were most associated with the LA echocardiographic variate. In the LA echocardiographic dataset, changes in LAScd, LASr, and LASr_c were most associated with the clinical variate.ConclusionCompared with HC, treatment-naïve patients with T2DM had lower LA function, and these patients benefited from dapagliflozin administration, particularly in LA function.