Effect Of Dapagliflozin On Cardiac Function In Patients With Type 2 Diabetes Mellitus And Heart Failure With Preserved Ejection Fraction

Objective: Heart failure with preserved ejection fraction（HFp EF）is a major type of heart failure（HF）.The risk of disease progression is very high,which will lead to clinical deterioration,repeated hospitalization and even death.A new oral hypoglycemic drug sodium glucose cotransporter 2（SGLT2）inhibitor can significantly improve the symptoms and quality of life of patients with heart failure with reduced ejection fraction.However,there are no definite research results that SGLT2 inhibitor can improve the symptoms and prognosis of patients with HFp EF.This study focused on the effect of SGLT2-inhibitor dapagliflozin on left ventricular ejection function,quality of life and inflammatory markers in patients with type 2 diabetes mellitus（T2DM）complicated with HFp EF.Methods: A total of 100 patients with T2 DM complicated with HFPEF treated with insulin hypoglycemic therapy in the Second Affiliated Hospital of Bengbu Medical College from September 2019 to September 2021 were randomly assigned to the observation group and the control group.The left ventricular ejection fraction（LVEF）,ventricular septal thickness,left ventricular end diastolic diameter,amino terminal precursor brain natriuretic peptide（NT Pro BNP）and Monocyte / high density lipoprotein cholesterol ratio（MHR）,C-reactive protein（CRP）and other blood indexes were detected.The Borg scale after six minutes walk test（6MWT）was used to judge the activity tolerance of patients,and the Kansas City Cardiomyopathy Questionnaire（KCCQ）was used to evaluate the quality of life of patients.After that,all patients in the observation group were added with dapagliflozin to control blood glucose on the basis of routine treatment,and the control group was added with acarbose to control blood glucose on the basis of routine treatment.The changes of LVEF,ventricular septal thickness,left ventricular end diastolic diameter,NT Pro BNP,KCCQ,MHR,CRP and6 MWT were followed up after 2,4 and 6 months of treatment.T-test and nonparametric test were used to compare the differences between the two groups.Results: After 2 months of treatment,the levels of MHR,CRP and Borg scale in the observation group were significantly lower than those in the control group（P <0.05）,but there was no significant difference in LVEF,ventricular septal thickness,left ventricular end diastolic diameter,NT Pro BNP and KCCQ between the two groups（P >0.05）;After 4 months of treatment,compared with the control group,the Borg scale,left ventricular end diastolic diameter,MHR and CRP of the observation group decreased significantly,and the scores of LVEF and KCCQ increased significantly（P<0.05）.There was no significant difference in ventricular septal thickness and NT Pro BNP between the two groups（P >0.05）;After 6 months of treatment,except for NT Pro BNP,there were significant differences in LVEF,ventricular septal thickness,left ventricular end diastolic diameter,KCCQ,Borg scale,MHR and CRP between the observation group and the control group（P <0.05）.The Borg scale,left ventricular end diastolic diameter,MHR and CRP in the observation group decreased significantly,and the scores of LVEF and KCCQ increased significantly.Although there were differences in the changes of ventricular septal thickness between the two groups,however,the change of ventricular septal thickness was not very significant.Conclusion: Dapagliflozin can alleviate the clinical symptoms of heart failure in patients with T2 DM complicated with HFp EF,improve the quality of life,improve the left ventricular ejection function,delay or even reverse ventricular enlargement to a certain extent.The inflammatory factor pathway may be one of the mechanisms of dapagliflozin to improve cardiac function.