Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece.
Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece.
Medicina (Kaunas). 2024 Feb 26;60(3):395. doi: 10.3390/medicina60030395.
: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are cardioprotective drugs. We investigated their effects on left atrial function, a major determinant of cardiac diastolic dysfunction in type 2 diabetes mellitus. We also explored the association of changes in arterial stiffness with those of the LA strain after treatment. : A total of 200 patients (59.5 ± 9.1 year old, 151 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n = 50 served as controls), liraglutide (n = 50), empagliflozin (n = 50) or their combination (liraglutide + empagliflozin) (n = 50). We measured at baseline and 6 months post-treatment: (a) left atrial and global left ventricular longitudinal strain by speckle tracking echocardiography; (b) pulse wave velocity (PWV) and central systolic blood pressure. : At baseline, there was a correlation of the LA reservoir strain with PWV (r = -0.209, = 0.008), central SBP (r = -0.151, = 0.030), EF (r = 0.214, = 0.004) and GLS (r = -0.279, = 0.009). The LA reservoir change 6 months post-treatment was correlated with the PWV change in all groups (r = -0.242, = 0.028). The LA reservoir change 6 months post-treatment was correlated with the GLS change in all groups (r = -0.322, = 0.004). Six months after intervention, patients treated with liraglutide, empagliflozin and their combination improved the left atrial reservoir strain (GLP1RA 30.7 ± 9.3 vs. 33.9 ± 9.7%, = 0.011, SGLT2i 30 ± 8.3 vs. 32.3 ± 7.3%, = 0.04, GLP1&SGLT2i 29.1 ± 8.7 vs. 31.3 ± 8.2, = 0.007) compared to those treated with insulin (33 ± 8.3% vs. 32.8 ± 7.4, = 0.829). Also, patients treated with liraglutide and the combination liraglutide and empagliflozin had improved left atrial conduction strain ( < 0.05). Empagliflozin or the combination liraglutide and empagliflozin showed a greater decrease of PWV and central and brachial systolic blood pressure than insulin or GLP-1RA. ( < 0.05). : Impaired aortic elastic properties are associated with a decreased LA strain in type 2 diabetics. Treatment with liraglutide, empagliflozin and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with the improvement of arterial and myocardial functions.
胰高血糖素样肽-1 受体激动剂 (GLP-1RA) 和钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT-2i) 是心脏保护性药物。我们研究了它们对 2 型糖尿病左心房功能的影响，左心房功能是心脏舒张功能障碍的主要决定因素。我们还探讨了治疗后动脉僵硬变化与左心房应变变化之间的关系。
共有 200 名接受二甲双胍治疗的 2 型糖尿病患者（59.5±9.1 岁，151 名男性）被随机分为胰岛素组（n=50 作为对照组）、利拉鲁肽组（n=50）、恩格列净组（n=50）或利拉鲁肽+恩格列净联合治疗组（n=50）。我们在基线和治疗 6 个月后测量：（a）左心房和整体左心室纵向应变的斑点追踪超声心动图；（b）脉搏波速度（PWV）和中心收缩压。
在基线时，LA 储存应变与 PWV（r=-0.209， = 0.008）、中心 SBP（r=-0.151， = 0.030）、EF（r=0.214， = 0.004）和 GLS（r=-0.279， = 0.009）呈相关性。治疗 6 个月后 LA 储存的变化与所有组的 PWV 变化呈相关（r=-0.242， = 0.028）。治疗 6 个月后 LA 储存的变化与所有组的 GLS 变化呈相关（r=-0.322， = 0.004）。干预 6 个月后，接受利拉鲁肽、恩格列净及其联合治疗的患者改善了左心房储存应变（GLP1RA 30.7±9.3%对比 33.9±9.7%， = 0.011，SGLT2i 30±8.3%对比 32.3±7.3%， = 0.04，GLP1&SGLT2i 29.1±8.7%对比 31.3±8.2%， = 0.007），与接受胰岛素治疗的患者相比（33±8.3%对比 32.8±7.4%， = 0.829）。此外，接受利拉鲁肽和联合治疗的患者左心房传导应变得到改善（ < 0.05）。与胰岛素或 GLP-1RA 相比，恩格列净或利拉鲁肽联合恩格列净治疗可更大程度地降低 PWV、中心和肱动脉收缩压（ < 0.05）。
受损的主动脉弹性与 2 型糖尿病患者的左心房应变降低有关。利拉鲁肽、恩格列净及其联合治疗 6 个月可改善左心房功能，与动脉和心肌功能改善平行，与胰岛素治疗相比，左心房功能改善更为明显。
