| Objective:In this study,we investigated the efficacy of sodium glucose cotransporter 2(SGLT2)inhibitor-dapagliflozin in patients with Chronic Heart Failure(CHF)with different groups divide by BMI.Methods:Chapter Ⅰ: In this study,CHF patients hospitalized in the Affiliated Hospital of Qingdao University from June 2020 to August 2022 were selected and divided into two groups according to the medication regimen: the dapagliflozin trial group(n=288 cases)and the non dapagliflozin control group(n=302 cases).Adopt the WHO BMI grading standard,Normal body weight(< 25kg/m2);Overweight(25.0-29.9 kg/m2);Obesity(≥30.0 kg/m2).To observe the changes in the rate of unplanned re admission to hospital due to heart failure(HF)and observe the changes of lipid metabolism indicators and left ventricular function indicators in patients with different BMI groups before and 12 months after medication.Metabolic indicators include total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDLC),uric acid(UA),urea nitrogen(BUN),and estimated glomerular filtration rate(e GFR).Cardiac color Doppler ultrasound observation indicators include: left ventricular early diastolic mitral valve blood flow maximum velocity(E)/early diastolic mitral annular peak velocity(E ’);Left atrial volume index(LAVI);Left ventricular mass index(LVMI).The primary end point was HF and unplanned re hospitalization;The secondary end point was to evaluate the changes in LVEF,LAVI,LVMI,TC,TG,HDL-C,LDL-C,UA,BUN,and e GFR from baseline in the experimental and control groups with different BMI groups by echocardiography after 12 months of treatment,and to analyze their correlation.Chapter Ⅱ: 105 elderly patients with type 2 diabetes combined with heart failure were selected as the study subjects,including 55 patients who were treated with dapagliflozin,50 patients with type 2 diabetes combined with heart failure who were not treated with dapagliflozin,and were followed up for 6 months.Compare the changes between the treatment group and the placebo group before and after treatment for 3 and 6 months.To explore the effect of dapagliflozin on lipid metabolism and uric acid metabolism in elderly type 2 diabetes patients with heart failure.Results:Chapter Ⅰ: To observe the effects of dapagliflozin on survival outcomes,left ventricular function,and metabolic indicators in patients with chronic heart failure with different body mass indexes.1.Among the included patients,the trial group and the control group were followed up for 12 months,and the rates of unplanned re admission due to HF were 58(20.9%)and91(32.6%).2.The average weight loss at 12 months of taking dapagliflozin was 0.70(0.30-1.70)Kg(P<0.001).There are significant differences in the risk of readmission due to heart failure among different BMI groups for CHF patients,with the obesity group receiving dapagliflozin showing the most significant decrease in readmission rate.3.There were differences in the E/e ’,LVEF,LVMI,and LAVI of patients treated with dapagliflozin among different BMI groups;Among them,the obesity group treated with dapagliflozin showed the greatest improvement in E/e ’,while the super recombinant patients showed the greatest improvement in LVEF,LAVI,and LVMI.4.There were differences in TC,TG,LDL-c,and UA among patients treated with dapagliflozin in different BMI groups,but there was no difference in HDL-c;Among them,the obese group treated with dapagliflozin had the largest decrease in cholesterol,while the super recombinant patients had the largest decrease in triglycerides and LDL-c.5.There were differences in creatinine,uric acid,and e GFR among patients treated with dapagliflozin in different BMI groups,but there was no difference in urea nitrogen;wherein,the obesity group had the largest decrease in uric acid,while the normal weight group had the most significant improvement in creatinine and e GFR.6.E/e ’was significantly negatively correlated with age,smoking history,drinking history,triglycerides,and was significantly positively correlated with uric acid.Triglycerides are independent risk factors for E/e ’.Chapter Ⅱ: Effects of dapagliflozin on metabolism in elderly patients with type 2diabetes and heart failure1.After treatment,the levels of blood lipids and uric acid metabolism in patients in the dapagliflozin treatment group improved compared to the previous treatment,with a statistically significant difference compared to the placebo group(P<0.05),and the effect of 6 months was better than that of 3 months.Conclusion:The rate of unplanned readmission due to HF,all-cause mortality,LVEF,LAVI,TC,TG,LDL-C,and UA in CHF patients with different BMI groups treated with daggliflozin were different;Application of daggliflozin had the same effect on all cause mortality,LVMI,HDL,urea nitrogen,and e GFR in CHF patients with different BMI groups.The cardiac function benefit of dapagliflozin for CHF patients was consistent within all BMI groups. |
