Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Cardiovascular and Arrhythmias Department "Gemelli Molise", Campobasso, Italy; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Metabolism. 2022 Dec;137:155243. doi: 10.1016/j.metabol.2022.155243. Epub 2022 Jun 19.
In patients with type 2 diabetes mellitus (T2DM) the vaso-vagal syncope (VVS) recurrence could be due to the alteration of autonomic system function, evaluated by heart rate variability (HRV), and by 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy indexes: Heart to Mediastinum ratio (H/M), and Washout rate (WR). The SGLT2-I could modulate/reduce autonomic dysfunction in T2DM patients with VVS. This effect could reduce the VVS recurrence in T2DM patients.
In a prospective multicenter study, after propensity score matching, we studied a population of 324 T2DM patients with VVS, divided into 161 SGLT2-I-users vs. 163 Non-SGLT2-I users. In these patients as SGLT2-I-users vs. Non-SGLT2-I users, we investigated the HRV and 123I-MIBG modifications and VVS recurrence at 12 months of follow-up.
At follow-up end, the SGLT2-I-users vs. Non-SGLT2-I users had best glucose homeostasis and lower values of inflammatory markers, and resting heart rate (p < 0.05). The SGLT2-I-users vs. Non-SGLT2-I users evidenced the lowest low frequency/high frequency ratio (LF/HFr), a significant difference for all the indexes of autonomic dysfunction via ECG Holter analysis, and higher values of H/M (p < 0.05). Finally, comparing SGLT2-I-users vs. Non-SGLT2-I users, we found a higher rate of VVS recurrence events, specifically of the vasodepressor VVS recurrence at 1-year follow-up (p < 0.05). We did not find a significant difference of mixed and cardio-inhibitory VVS recurrence events at 1 year of follow-up in the study cohorts (p > 0.05). At the Cox regression analysis H/M (0.710, [0.481-0.985]), and SGLT2-I therapy (0.550, [0.324-0.934]) predicted all causes of syncope recurrence at 1 year of follow-up.
Non-SGLT2-I users vs. SGLT2-I-users had alterations of the autonomic nervous system, with a higher rate of VVS recurrence at 1 year of follow-up. The indexes of cardiac denervation predicted the VVS recurrence, while the SGLT2-I reduced the risk of VVS recurrence.
NCT03717207.
在 2 型糖尿病（T2DM）患者中，血管迷走神经性晕厥（VVS）的复发可能是由于自主神经系统功能的改变，通过心率变异性（HRV）和 123I-间位碘苄胍（123I-mIBG）心肌闪烁显像指标评估：心-纵隔比（H/M）和洗脱率（WR）。SGLT2-I 可调节/降低 VVS 伴 T2DM 患者的自主神经功能障碍。这种作用可以降低 T2DM 患者 VVS 的复发率。
在一项前瞻性多中心研究中，通过倾向评分匹配后，我们研究了 324 例 VVS 的 T2DM 患者，分为 SGLT2-I 使用者 161 例和非 SGLT2-I 使用者 163 例。在这些患者中，SGLT2-I 使用者与非 SGLT2-I 使用者相比，我们在 12 个月的随访中观察了 HRV 和 123I-MIBG 变化以及 VVS 复发情况。
随访结束时，SGLT2-I 使用者与非 SGLT2-I 使用者的血糖稳态最佳，炎症标志物和静息心率值较低（p<0.05）。SGLT2-I 使用者与非 SGLT2-I 使用者的低频/高频比值（LF/HFr）最低，通过心电图 Holter 分析发现所有自主神经功能障碍指标均有显著差异，H/M 值较高（p<0.05）。最后，与 SGLT2-I 使用者相比，非 SGLT2-I 使用者在 1 年随访时出现 VVS 复发事件的比例更高，特别是血管扩张性 VVS 复发事件（p<0.05）。在研究队列中，1 年随访时混合性和心脏抑制性 VVS 复发事件无显著差异（p>0.05）。在 Cox 回归分析中，H/M（0.710，[0.481-0.985]）和 SGLT2-I 治疗（0.550，[0.324-0.934]）可预测 1 年随访时所有原因引起的晕厥复发。
非 SGLT2-I 使用者与 SGLT2-I 使用者的自主神经系统发生改变，1 年随访时 VVS 复发率较高。心脏去神经支配的指标预测了 VVS 的复发，而 SGLT2-I 降低了 VVS 复发的风险。
NCT03717207。
