Effect of dapagliflozin on the dynamics of magnetic resonance imaging in patients with heart failure and atrial fibrillation

Cover Page

Cite item

Full Text

Abstract

Aim. To determine the effect of dapagliflozin therapy on myocardial remodeling and fibrosis according to magnetic resonance imaging (MRI) with contrast in patients with chronic heart failure (CHF) and atrial fibrillation (AF).

Materials and methods. In the group of 22 patients with a combination of CHF and AF we analyzed the dynamics of remodeling parameters and assessed myocardial fibrosis during 6-month therapy with dapagliflozin according to cardiac MRI with contrast.

Results.  After 6 months of dapagliflozin therapy there was a statistically significant increase in LVEF (27 [23-32]-32 [26.5-36.5] p-0.04) and a tendency to decrease volume and linear dimensions of LV, LP. There was no progression of myocardial fibrosis according to the results of cardiac MRI with contrast in patients with HFrFV and AF.

Conclusions. Dapagliflozin therapy in patients with HFrEF and AF led to favorable myocardial remodeling changes.

About the authors

Karina M. Saipudinova

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: saiputdinova93@mail.ru
ORCID iD: 0000-0002-3757-1160

doctor-graduate student dept. myocardial diseases and heart failure

Russian Federation, Moscow

Tatiana M. Uskach

Chazov National Medical Research Center of Cardiology; Russian Medical Academy of Continuous Professional Education

Email: tuskach@mail.ru
ORCID iD: 0000-0003-4318-0315

Doctor of Medical Sciences, Ved. Researcher Dept. myocardial diseases and heart failure, professor of the Department of Cardiology

Russian Federation, Moscow; Moscow

Merab А. Shariya

Chazov National Medical Research Center of Cardiology; Sechenov First Moscow State Medical University (Sechenov University)

Email: mershar@yandex.ru
ORCID iD: 0000-0002-0370-5204

Doctor of Medical Sciences, Ved. Researcher at the Department of Tomography, Professor at the Department of Radiation Diagnostics and Radiation Therapy

Russian Federation, Moscow; Moscow

Dmitry V. Ustyuzhanin

Chazov National Medical Research Center of Cardiology

Email: d-ust@yandex.ru
ORCID iD: 0000-0002-0402-3977

Candidate of Medical Sciences, Senior Researcher, Tomography Department

Russian Federation, Moscow

Svetlana V. Dobrovolskaya

Chazov National Medical Research Center of Cardiology

Email: S_dobrovolskaya@mail.ru
ORCID iD: 0000-0003-0580-393X

junior researcher dept. ultrasound research methods

Russian Federation, Moscow

Sergey N. Tereshchenko

Chazov National Medical Research Center of Cardiology

Email: tereschenko@yandex.ru
ORCID iD: 0000-0001-9234-6129

Doctor of Medical Sciences, Professor, Head of Department. myocardial diseases and heart failure

Russian Federation, Moscow

References

  1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022; 24(1):4-131. doi: 10.1002/ejhf.2333
  2. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017 Apr;3(1):7-11. doi: 10.15420/cfr.2016:25:2.
  3. Chiang CE, Naditch-Brule L, Murin J, Goethals M, Inoue H, O'Neill J, Silva-Cardoso J, Zharinov O, Gamra H, Alam S, Ponikowski P, Lewalter T, Rosenqvist M, Steg PG. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circulation: Arrhythmia and Electrophysiology. 2012;5(4):632-639.
  4. Weber C, Hung J, Hickling S, Nedkoff L, Murray K, Li I, Briffa TG. Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation. Heart (British Cardiac Society). 2021;107(16):1320-1326. doi: 10.1136/heartjnl-2020-318648.
  5. Kim MH, Johnston SS, Chu BC, Dalal MR, Schulman KL. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011 May;4(3):313-20. doi: 10.1161/CIRCOUTCOMES.110.958165.
  6. Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail. 2009 Jul;11(7):676-83. doi: 10.1093/eurjhf/hfp085.
  7. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. doi: 10.1093/eurheartj/ehw128
  8. Терещенко С. Н., Галявич А. С., Ускач Т.М. и др. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11): 4083 [Tereshchenko S.N., Galyavich A.S., Uskach T.M. 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.)] doi: 10.15829/1560-4071-2020-4083
  9. Maddox TM, Januzzi JL, Larry A, Butler LAJ, Davis LL, Fonarow GC, Ibrahim, Jessup NEM, Lindenfeld JA, Maddox TM, Masoudi FA, Motiwala SR, Patterson JH, Walsh MN, Wasserman A. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2021;77(6):772-810. https://doi.org/10.1016/j.jacc.2020.11.022 18. Global, regional, and national burden of chronic kidney disease
  10. McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Anand IS Bělohlávek J, Böhm M, Chiang CE, Chopra VK, de Boer RA, Desai AS, Diez M, Drozdz J, Dukát A, Ge J, Howlett JG, Katova T, Kitakaze M, Ljungman CEA, Merkely B, Nicolau JC, O'Meara E, Petrie MC, Vinh PN, Schou M, Tereshchenko S, Verma S, Held C, DeMets DL, Docherty KF, Jhund PS, Bengtsson O, Sjöstrand M, Langkilde AM; DAPA-HF Trial Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21; 381(21):1995-2008. doi: 10.1056/NEJMoa1911303.
  11. Kramer DG, Trikalinos TA, Kent DM, et al. Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach. J Am Coll Cardiol. 2010;56:392-406. doi: 10.1016/j.jacc.2010.05.011.
  12. Triposkiadis F, Pieske B, Butler J, et al. Global left atrial failure in heart failure. Eur J Heart Fail. 2016;18:1307-20. doi:10.1002/ ejhf.645.
  13. The pathogenesis of cardiac fibrosis, Ping Kong, Panagiota Christia, Nikolas G. Frangogiannis, Cellular and Molecular Life Sciences volume 71, pages549–574 (2014)
  14. Flett AS, Hasleton J, Cook C, Hausenloy D, Quarta G, Ariti C, Muthurangu V, Moon JC. Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. JACC Cardiovasc Imaging. 2011 Feb;4(2):150-6. doi: 10.1016/j.jcmg.2010.11.015.
  15. Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G, Brueckmann M, Ofstad AP, Pfarr E, Jamal W, Packer M. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020 Sep 19;396(10254):819-829. doi: 10.1016/S0140-6736(20)31824-9.
  16. Jariwala P, Jadhav K, Punjani A, Boorugu H, Mari AR. ADDition of DAPAgliflozin, Sodium-Glucose Cotransporter-2 Inhibitor to Angiotensin Receptor Blocker-Neprilysin Inhibitors Non-Responders in Patient with Refractory Heart Failure with Reduced Ejection Fraction (ADD DAPA trial). Indian Heart J. 2021 Sep-Oct;73(5):605-611. doi: 10.1016/j.ihj.2021.07.005.
  17. Xue L, Yuan X, Zhang S, Zhao X. Investigating the Effects of Dapagliflozin on Cardiac Function, Inflammatory Response, and Cardiovascular Outcome in Patients with STEMI Complicated with T2DM after PCI. Evid Based Complement Alternat Med. 2021 Oct 15;2021:9388562. doi: 10.1155/2021/9388562
  18. Wang H, Ding L, Tian L, Tian Y, Liao L, Zhao J. Empagliflozin reduces diffuse myocardial fibrosis by extracellular volume mapping: A meta-analysis of clinical studies. Front Endocrinol (Lausanne). 2022 Aug 11;13:917761. doi: 10.3389/fendo.2022.917761.
  19. Lee TM, Chang NC, Lin SZ. Dapagliflozin, a selective SGLT2 Inhibitor, attenuated cardiac fibrosis by regulating the macrophage polarization via STAT3 signaling in infarcted rat hearts. Free Radic Biol Med. 2017 Mar;104:298-310. doi: 10.1016/j.freeradbiomed.2017.01.035.
  20. Tian J, Zhang M, Suo M, Liu D, Wang X, Liu M, Pan J, Jin T, An F. Dapagliflozin alleviates cardiac fibrosis through suppressing EndMT and fibroblast activation via AMPKα/TGF-β/Smad signalling in type 2 diabetic rats. J Cell Mol Med. 2021 Aug;25(16):7642-7659. doi: 10.1111/jcmm.16601.
  21. Li C, Zhang J, Xue M, Li X, Han F, Liu X, Xu L, Lu Y, Cheng Y, Li T, Yu X, Sun B, Chen L. SGLT2 inhibition with empagliflozin attenuates myocardial oxidative stress and fibrosis in diabetic mice heart. Cardiovasc Diabetol. 2019 Feb 2;18(1):15. doi: 10.1186/s12933-019-0816-2.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Cardiac MRI, Cine MRI (pulse sequence True FISP). Four-chamber section. Diastole (a, b), systole (c, d). Images before treatment (a, c) and after treatment (b, d).

Download (159KB)
Indexing metadata
3. Fig. 2. Cardiac MRI with delayed contrast after introduction of gadolinium containing drug (pulse sequence PSIR). A section on the short axis of the left ventricle (a, c) and a four-chamber projection (b, d). The arrows mark the postinfarction cicatricial changes. Images before treatment (a, b) and after treatment (c, d).

Download (131KB)
Indexing metadata

Copyright (c) 2023 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies