Dapagliflozin Influences Ventricular Hemodynamics and Exercise-Induced Pulmonary Hypertension in Type 2 Diabetes Patients　- A Randomized Controlled Trial.

Abstract

BACKGROUND:

This prospective randomized multicenter open-label trial evaluated whether sodium-glucose cotransporter-2 inhibitor (SGLT2-i) improves left ventricular (LV) pump function and suppresses elevation of LV filling pressure (LVFP) and right ventricular systolic pressure (RVSP) during exercise in type 2 diabetes mellitus (T2DM) patients.Methods and Results:Based on HbA1c and LV ejection fraction, 78 patients with poorly controlled T2DM were randomly assigned to D-group (dapagliflozin 5 mg/day add-on) or C-group (conventional therapy add-on). Physical examination, home and office blood pressure examination, blood tests, and echocardiography at rest and during ergometer exercise were performed at baseline and at 1.5 and 6 months after treatment. The primary endpoint was defined as the change in RVSP (mmHg) between baseline and 6-month follow up. The secondary endpoints were changes in LVFP (ratio), stroke volume index (SVi; mL/m2), and cardiac index (CI; L/min/m2). Both RVSP and LVFP during exercise significantly decreased from baseline to 6 months after starting treatment in the D-group (P<0.001). No changes to either parameter was observed in the C-group. The SVi and CI did not improve in either group. Both home and office blood pressure significantly decreased in the D-group. Decreases in HbA1c were somewhat greater in the C-group.

CONCLUSIONS:

Dapagliflozin significantly improved RVSP and LVFP during exercise in patients with T2DM and cardiovascular risk, which may contribute to favorable effects on heart failure.

• Authors: Hiroyuki Kayano, Shinji Koba, Tsutomu Hirano, Taiju Matsui, Hiroto Fukuoka, Hiroaki Tsuijita, Shigeto Tsukamoto, Toshiyuki Hayashi, Tsutomu Toshida, Norikazu Watanabe, Yuji Hamazaki, Eiichi Geshi, Mikitaka Murakami, Kazuo Aihara, Koujin Kaneko, Hirokazu Yamada, Youichi Kobayashi, Toshiro Shinke
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 84 Issue 10 Pg. 1807-1817 (09 25 2020) ISSN: 1347-4820 [Electronic] Japan
• PMID: 32921680 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Benzhydryl Compounds
• Glucosides
• Glycated Hemoglobin A
• Sodium-Glucose Transporter 2 Inhibitors
• hemoglobin A1c protein, human
• dapagliflozin

Topics

• Aged
• Benzhydryl Compounds (administration & dosage)
• Blood Pressure (drug effects)
• Diabetes Mellitus, Type 2 (blood, complications, epidemiology)
• Exercise
• Female
• Follow-Up Studies
• Glucosides (administration & dosage)
• Glycated Hemoglobin (analysis)
• Heart Failure (prevention & control)
• Humans
• Hypertension, Pulmonary (blood, complications, drug therapy, epidemiology)
• Japan (epidemiology)
• Male
• Middle Aged
• Prospective Studies
• Sodium-Glucose Transporter 2 Inhibitors (administration & dosage)
• Stroke Volume (drug effects)
• Treatment Outcome
• Ventricular Function, Left (drug effects)