Efficacy Of Dapagliflozin In Patients With Heart Failure With Preserved Ejection Fraction And Type 2 Diabetes

Objective:Patients with heart failure(HF)are usually classified into Heart Failure with Reduced Ejection Fraction(HFr EF),Heart Failure with Mid-Range Ejection Fraction(HFmr EF),and Heart Failure with Preserved Ejection Fraction(HFp EF).HFp EF is a multifactorial disease whose prevalence is expected to increase dramatically in the coming years and may become the leading cause of HF in the near future.HFp EF has a poor prognosis,with a 5-year mortality rate of 10%-30%,and there is no evidence that conventional HF treatment improves the prognosis of patients with HFp EF compared to HFr EF.A strong correlation between HF and type-2 diabetes mellitus(T2DM)has been found,with a greater correlation between HFp EF and T2 DM than HFr EF,which may be due to common pathophysiological mechanisms,including increased inflammation,abnormal angiogenesis and remodeling,impaired cardiac metabolism,impaired insulin signaling alterations,and deposition of late glycosylation end products in the myocardium.Therefore,reducing or reversing these changes has potential cardiovascular benefits in patients with HFp EF combined with T2 DM.Recent research evidence suggests that metabolic agents such as Sodium Glucose Transporter 2 inhibitor(SGLT2i)may be of value in the treatment of patients with HFp EF with T2 DM,and SGLT2 i may improve cardiovascular outcomes in patients with HFp EF,delay the SGLT2 i may improve cardiovascular outcomes and delay the onset and progression of HFp EF in patients with HFp EF,providing a novel idea and approach for the treatment of HFp EF.In addition,several studies have reported the cardiovascular benefits of SGLT2 i in HFp EF and improved cardiac diastolic function in patients.The aim of this study was to observe the clinical effects of SGLT2 i Dapagliflozin in patients with HFp EF with T2 DM.Methods:Patients admitted to the Cardiovascular Medicine Department of The First Affiliated Hospital of Zhengzhou University hospital from March 1,2020 to June 30,2020,were clinically diagnosed as HFp EF with T2 DM,excluded by nadir criteria,and randomly divided into a control group(not treated with Dapagliflozin)and an experimental group(treated with Dapagliflozin)according to whether Dapagliflozin was applied in clinical treatment,Both groups were routinely treated with anti-HF drugs and hypoglycemic drugs,and the experimental group was treated with Dapagliflozin 10mg/d.The patients in the two groups were compared at the time of admission and after 6 months of treatment,the 6 minutes walk test(6MWT)distance,body mass index(BMI),glycated hemoglobin(Hb A1c)level,N-terminal B-type natriuretic peptide(N-terminal pro-BNP,NT-pro BNP),left ventricular end-diastolic volume(LVEDV),left atrial internal diameter,left atrial volume index(LAVI),and other clinical indicators,The clinical indexes such as LVEDV,LAVI,etc.were evaluated after 6 months of treatment,and the disease control in the experimental and control groups was assessed.Results:1.At admission,there was no treatment difference between the two groups in terms of past medical history,general information,medication regimen,and pre-treatment baseline level(P>0.05).2.After 6 months of treatment,the levels of NT-pro BNP and Hb A1 c in the experimental group and the control group were lower than those before treatment,and the decrease was more significant in the experimental group(P < 0.05).3.After 6 months of treatment,the LVEDV,left atrial internal diameter,and LAVI values in the experimental and control groups were lower than before treatment,and the decrease was more significant in the experimental group(P < 0.05).4.After 6 months of treatment,the BMI values of both the experimental and control groups decreased compared with those before treatment,and the decrease was more significant in the experimental group(P < 0.05).5.After 6 months of treatment,the 6MWT distance increased in both the experimental and control groups compared with that before treatment,and the increase was more significant in the experimental group(P < 0.05).6.During the treatment follow-up period,there were 3 cases of rehospitalization due to HF in the experimental group and 10 cases of rehospitalization due to HF in the control group,and after comparison between the groups,the results showed that the difference in readmission rate between the two groups was statistically significant(P < 0.05),and the control group was significantly higher than the experimental group.7.After 6 months of treatment,there was no significant difference between the two groups in terms of complications and cardiovascular outcomes(P>0.05).Conclusions:Dapagliflozin is safe and effective in routine clinical administration of ejection fraction retention heart failure patients with type 2 diabetes mellitus improves cardiac function,disease control rate and quality of life of patients.