Effect Of SGLT-2 Inhibitors On Left Atrial Remodeling And Prognosis In Patients With HFrEF And Type 2 Diabetes

Background and Objective: Heart failure(HF)is a group of syndromes caused by structural abnormalities and dysfunctions of the heart caused by different causes develop to terminal stage,which are characterized by high morbidity,high mortality,and high economic burden on patients and society.Cardiac remodeling is an important mechanism that leads to the development and progression of chronic heart failure,and this remodeling occurs not only in the ventricle but also in the atrium.New guidelines released by the American College of Cardiology/American Heart Association/American Heart Association(ACC/AHA/HFSA)in 2022 recommend sodium-glucose cotransporter 2(SGLT-2)inhibitors as Class 1A recommendations for symptomatic chronic heart failure with reduced ejection fraction,(HFrEF)to reduce cardiovascular hospitalization and mortality,with or without type 2 diabetes.SGLT-2 inhibitors are a class of non-insulin-dependent hypoglycemic agents that have demonstrated significant cardiovascular benefit in patients with diabetes and non-diabetic,acute and chronic HF in multiple cardiovascular outcome trials(CVOTs).Some studies have shown that reversing left ventricular remodeling may be one of the important mechanisms by which SGLT-2 inhibitors exert cardioprotective effects.However,there have been fewer studies on the effect of SGLT-2 inhibitors on left atrial remodeling.The objective of this study was to explore the effect of SGLT-2 inhibitors on left atrial remodeling and prognosis in patients with HFrEF and type 2 diabetes.Methods: Patients with HFrEF and type 2 diabetes mellitus who were hospitalized in the First Affiliated Hospital of Da Lian Medical University from January 1,2019 to March 1,2022 were retrospectively collected,and were divided into SGLT-2 inhibitor group and non-SGLT-2 inhibitor group.All patients were followed up to compare change in left atrial remodeling from baseline,proportion of patients with left atrial reverse remodeling(LARR),change in HF prognosis-related biomarkers from baseline,and all-cause mortality.Results: Finally,198 patients(mean age: 63.96±12.11 years old,female :20.71%)were enrolled,99 patients in the SGLT-2 inhibitor group and 99 in the non-SGLT-2inhibitor group were included.The median follow-up was 11 months.1.Comparison of change in left atrial remodeling indexes between the two groups: The improvement of left atrial structure remodeling indexes in the SGLT-2inhibitor group was more significant than in the non-SGLT-2 inhibitor group include left atrial diameter(P < 0.001),left atrial superior–inferior diameter(P =0.027),left atrial transverse diameter(P=0.020),left atrial volume(P=0.005),and left atrial volume index(P=0.004).Moreover,48 patients(48.48%)in the SGLT-2i group and 33(33.33%)in the non-SGLT-2i group showed LARR(P=0.003).2.Comparison of changes in HF prognosis-related biomarkers between the two groups: The follow-up BNP level in the SGLT-2 inhibitor group decreased significantly from baseline(-171.81 pg/m L)than in the non-SGLT-2 inhibitor group(-6.06 pg/m L)(P = 0.027).Patients in the SGLT-2 inhibitor group were followed up with a decrease in hs-Tn I levels from baseline(-0.04 μg/L),and hs-Tn I levels in the nonSGLT-2 inhibitor group progressed slightly from baseline(0.01 μg/L)(P = 0.027).3.Prognosis between the two groups: After a mean follow-up of 11 months,a total of 38 patients died,including 12(12.1%)in the SGLT-2 inhibitor group and 26(26.3%)in the non-SGLT-2 inhibitor group,and the survival curve showed that the survival status difference between the two groups was statistically significant(p=0.018).Univariate Cox regression analysis further showed that the risk of all-cause mortality was lower in the SGLT-2 inhibitor group than in the non-SGLT-2 inhibitor group[hazard ratio(HR)=0.451,95% confidence interval(95% CI): 0.227-0.898,P =0.023].This association persisted after adjustment for multivariate Cox regression analysis(HR= 0.289,95% CI: 0.100-0.808,P = 0.020).Conclusion1.SGLT-2 inhibitors are beneficial in reversing left atrial remodeling in patients with HFrEF and type 2 diabetes,and this beneficial effect may be one of the important mechanisms for their cardiovascular protection.2.SGLT-2 inhibitors can reduce the level of HF prognosis-related biomarkers in HFrEF and type 2 diabetes.3.SGLT-2 inhibitors can reduce all-cause mortality and improve outcomes in patients with HFrEF and type 2 diabetes.