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Observational Study
. 2018 May 22;17(1):73.
doi: 10.1186/s12933-018-0717-9.

Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes

Daisuke Matsutani  1 , Masaya Sakamoto  2 , Yosuke Kayama  3 , Norihiko Takeda  4 , Ryuzo Horiuchi  5 , Kazunori Utsunomiya  1
Affiliations
Observational Study

Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes

Daisuke Matsutani et al. Cardiovasc Diabetol. .

Abstract

Background: Type 2 diabetes mellitus (T2DM) greatly increases the risks of cardiovascular disease and heart failure. In particular, left ventricular diastolic dysfunction that develops from the early stages of T2DM is an important factor in the onset and exacerbation of heart failure. The effect of sodium-glucose cotransporter 2 inhibitors on left ventricular diastolic function has not been elucidated. We have performed the first prospective study on the effects of canagliflozin on left ventricular diastolic function in T2DM.

Methods: This study was performed to evaluate the effects of additional treatment with canagliflozin for 3 months on left ventricular diastolic function in patients with T2DM. A total of 38 patients with T2DM were consecutively recruited for this study. Left ventricular diastolic function was assessed by echocardiography. The primary study outcome was a change in the septal E/e' as a parameter of left ventricular diastolic function.

Results: A total of 37 patients (25 males and 12 females) were included in the analysis. Mean age of participants was 64.2 ± 8.1 years (mean ± SD), mean duration of diabetes was 13.5 ± 8.1 years, and mean HbA1c was 7.9 ± 0.7%. Of the participants, 86.5% had hypertension, 100% had dyslipidemia, and 32.4% had cardiovascular disease. Canagliflozin significantly improved left ventricular diastolic function (septal E/e' ratio 13.7 ± 3.5-12.1 ± 2.8, p = 0.001). Furthermore, among the various parameters that changed through the administration of canagliflozin, only changes in hemoglobin significantly correlated with changes in the septal E/e' ratio (p = 0.002). In multiple regression analysis, changes in hemoglobin were also revealed to be an independent predictive factor for changes in the septal E/e' ratio.

Conclusions: This study showed for the first time that canagliflozin could improve left ventricular diastolic function within 3 months in patients with T2DM. The benefit was especially apparent in patients with substantially improved hemoglobin values. Trial registration UMIN Clinical Trials Registry UMIN000028141.

Keywords: Autonomic function; Heart failure with preserved ejection fraction; Left ventricular diastolic function; Sodium-glucose cotransporter 2 inhibitors; Type 2 diabetes mellitus.

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Figures

Fig. 1
Fig. 1
Figure title: Septal E/e′ ratio, left ventricular mass index, EF, heart rate, baroreflex sensitivity, and LF/HF at baseline (pre-canagliflozin) and at the 3-month follow-up (post-canagliflozin). Data are mean ± SD or median (25th–75th percentiles). E velocity of early mitral flow; e′, early peak velocity of septal annulus; LVMI left ventricular mass index; EF ejection fraction; BRS baroreflex sensitivity; LF/HF low frequency/high frequency; SD standard deviation; IQR interquartile range
Fig. 2
Fig. 2
Comparison of changes in septal E/e′ ratio with baseline septal E/e′ ratio based on ANOVA. Changes in the septal E/e′ ratio divided according to baseline septal E/e′ ratio tertiles. Tukey post hoc test compared with T1. E velocity of early mitral flow; e′ early peak velocity of septal annulus
See this image and copyright information in PMC

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