Effect of Dapagliflozin Treatment on Index of Cardiac Electrophysiological Balance in Patients With Heart Failure With Reduced Ejection Fraction.

BACKGROUND

Dapagliflozin (DAPA), a sodium-glucose cotransporter-2 (SGLT2) inhibitor, may attenuate the risk of ventricular arrhythmia (VA) through its antiarrhythmic properties in patients with heart failure with reduced ejection fraction (HFrEF). The antiarrhythmic mechanisms of SGLT2 inhibitors are not fully known. Recently, the index of cardiac electrophysiological balance (ICEB) has been posited as a robust indicator for predicting VA risk. ICEB reflects the balance between ventricular depolarization and repolarization. This study was conducted to investigate the effects of DAPA treatment on ICEB in a cohort of patients with HFrEF.

METHODS

A total of 235 HFrEF patients undergoing DAPA treatment were enrolled in the study. Each participant underwent a comprehensive 12-lead electrocardiography (ECG) assessment prior to treatment initiation and approximately 6 months posttreatment. ICEB values were compared before and after treatment.

RESULTS

The analysis revealed a statistically significant reduction in the QT interval (427.51 ± 13.87 vs. 347.75 ± 11.21 ms, p < 0.001), corrected QT interval (QTc) (458.34 ± 29.71 vs. 393.37 ± 13.21 ms, p < 0.001), T peak-to-end (Tp-e) interval (85.41 ± 3.52 vs. 71.18 ± 3.16 ms, p < 0.001), Tp-e/QTc ratio (0.186 ± 0.009 vs. 0.180 ± 0.003, p < 0.001), ICEB (4.59 ± 0.65 vs. 3.77 ± 0.15, p < 0.001), following approximately 6 months of DAPA treatment.

CONCLUSION

In addition to ventricular repolarization distribution indices, the regression of the ICEB values after DAPA treatment in patients with HFrEF shows that DAPA treatment improves the balance between ventricular depolarization and repolarization and reduces the risk of VA in these patients.