Background

The 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.

Methods

4D 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.

Results

This 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 %, p_adjusted = 0.017; LAScd: -11.51 ± 4.48 vs. -16.74 ± 4.51 %, p_adjusted = 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 %, p_adjusted < 0.001; LAScd: -11.51 ± 4.48 vs. -12.75 ± 4.70 %, p_adjusted < 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.

Conclusion

Compared with HC, treatment-naïve patients with T2DM had lower LA function, and these patients benefited from dapagliflozin administration, particularly in LA function.

中文翻译：

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3 个月达格列净对初治 2 型糖尿病患者左心房功能的影响：使用 4 维超声心动图评估

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 (T2DM) 患者的左心室 (LV) 功能。然而，对初治 T2DM 患者左心房 (LA) 功能的影响仍不清楚。我们研究的目的是 1) 使用 4 维自动 LA 定量 (4D Auto LAQ) 调查达格列净 3 个月治疗对初治 T2DM 患者 LA 功能的影响，2) 探索相关的协变模式临床和 LA 超声心动图变量的变化。

方法

4D Auto LAQ 用于评估初治 T2DM 患者在基线、随访和健康对照 (HC) 时的 LA 体积、纵向和周向应变。进行稀疏典型相关分析 (sCCA)，以捕获初治 T2DM 患者组中临床和 LA 超声心动图变量变化之间的关联协变模式。

结果

这项研究最终纳入了 61 名未接受过治疗的无心血管疾病的 T2DM 患者和 39 名健康对照 (HC)。与 HC 相比，初治 T2DM 患者基线时 LA 储库和导管功能降低，与年龄、性别、BMI 和血压无关（LASr：21.11 ± 5.39 对比 27.08 ± 5.31 %，p调整₌ 0.017；LAScd：-11.51 ± 4.48 与 -16.74 ± 4.51 %，p_调整= 0.013）。使用达格列净治疗 3 个月后，T2DM 患者的 LA 储库和导管功能显着改善，与 BMI 和血压变化无关（LASr：21.11 ± 5.39 对比 23.84 ± 5.74 %，p_调整后< 0.001；LAScd：-11.51 ± 4.48对比 -12.75 ± 4.70 %，p_调整< 0.001）。临床和 LA 超声心动图参数显示显着的协变（r = 0.562，p = 0.039）。在临床数据集中，心率、胰岛素和体重指数的变化与 LA 超声心动图变量最相关。在 LA 超声心动图数据集中，LAScd、LASr 和 LASr_c 的变化与临床变量最相关。

结论

与 HC 相比，初治 T2DM 患者的 LA 功能较低，这些患者受益于达格列净给药，特别是在 LA 功能方面。