即使在无心血管疾病的糖尿病患者中，早期使用2型钠-葡萄糖协同转运蛋白抑制剂（SGLT2i）是否必要：一项关于SGLT2i对左心室舒张功能影响的前瞻性研究。

Is early use of sodium-glucose cotransporter type 2 inhibitor (SGLT2i) necessary even in diabetic patients without cardiovascular disease: a prospective study regarding the effect of SGLT2i on left ventricular diastolic function.

作者信息

Jeon Kina, Jang Shin Yi, Lee You-Bin, Kim Jihoon, Kim Darae, Chang Sung-A, Park Sung-Ji, Lee Sang-Chol, Park Seung Woo, Lee Moon-Kyu, Kim Eun Kyoung, Hur Kyu Yeon

机构信息

Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea.

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

J Cardiovasc Imaging. 2025 Jan 13;33(1):1. doi: 10.1186/s44348-024-00043-0.

DOI:10.1186/s44348-024-00043-0

PMID:39806504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11727183/

Abstract

BACKGROUND

There are insufficient studies to determine whether sodium-glucose cotransporter type 2 inhibitors (SGLT2i) will help reduce early diabetic cardiomyopathy, especially in patients without documented cardiovascular disease.

METHODS

We performed a single center, prospective observation study. A total of 90 patients with type 2 diabetes patients without established heart failure or atherosclerotic cardiovascular disease were enrolled. Echocardiography, cardiac enzyme, and glucose-control data were examined before and 3 months after the administration of SGLT2i (dapagliflozin 10 mg per day). Cardiovascular risk factors included hypertension, smoking, obesity, dyslipidemia, and old age. The primary end point was the change of E/e' before and after administration of SGLT2i.

RESULTS

Most patients (86.7%) had three or more cardiovascular risk factors, and about 32% had all five risk factors. Although the decrease in E/e' after the administration of SGLT2i was observed in 20% of enrolled patients, there was no significant difference in average E/e' value or left atrial volume index before and after the SGLT2i medication. Even in patients with all known risk factors including old age, E/e' value did not decrease after adding SGLT2i (8.9 ± 2.4 vs. 8.7 ± 3.2). There was a statistically significant difference in E/e' change after the SGLT2i administration between patients younger than 60 years and those older than 60 years (-0.7 ± 2.2 vs. 1.1 ± 2.8, P = 0.002).

CONCLUSIONS

In type 2 diabetes patients without documented cardiovascular disease including heart failure, administration of SGLT2i showed no improvement in diastolic function profile. Further large-scale randomized studies are needed to determine who will benefit from potential cardiovascular events with early addition of SGLT2i.

摘要

背景

目前尚无足够的研究来确定钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是否有助于减轻早期糖尿病性心肌病，尤其是在无心血管疾病记录的患者中。

方法

我们进行了一项单中心前瞻性观察研究。共纳入90例无心力衰竭或动脉粥样硬化性心血管疾病的2型糖尿病患者。在给予SGLT2i（达格列净每日10毫克）之前和之后3个月，检查超声心动图、心肌酶和血糖控制数据。心血管危险因素包括高血压、吸烟、肥胖、血脂异常和老年。主要终点是给予SGLT2i前后E/e'的变化。

结果

大多数患者（86.7%）有三种或更多心血管危险因素，约32%的患者具备所有五种危险因素。尽管在20%的入组患者中观察到给予SGLT2i后E/e'降低，但SGLT2i用药前后平均E/e'值或左心房容积指数无显著差异。即使在包括老年在内的所有已知危险因素的患者中，添加SGLT2i后E/e'值也未降低（8.9±2.4对8.7±3.2）。60岁以下患者与60岁以上患者在给予SGLT2i后E/e'变化存在统计学显著差异（-0.7±2.2对1.1±2.8，P = 0.002）。