Kayhan Yusuf, Kaya Hakan, Kavalci Veysi, Abus Sabri, Biyikli Kadir, Markirt Sezer, Can Cemil, Markirt Erkan, Özdemir Deniz Merde
Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
Department of Endocrinology and Metabolism, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
Ann Noninvasive Electrocardiol. 2025 Sep;30(5):e70101. doi: 10.1111/anec.70101.
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.
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.
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.
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.
达格列净（DAPA）是一种钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，在射血分数降低的心力衰竭（HFrEF）患者中，它可能通过其抗心律失常特性降低室性心律失常（VA）的风险。SGLT2抑制剂的抗心律失常机制尚不完全清楚。最近，心脏电生理平衡指数（ICEB）已被认为是预测VA风险的可靠指标。ICEB反映心室去极化和复极化之间的平衡。本研究旨在调查DAPA治疗对一组HFrEF患者ICEB的影响。
共有235例接受DAPA治疗的HFrEF患者纳入本研究。每位参与者在开始治疗前和治疗后约6个月接受了全面的12导联心电图（ECG）评估。比较治疗前后的ICEB值。
分析显示，经过约6个月的DAPA治疗后，QT间期（427.51±13.87 vs. 347.75±11.21 ms，p<0.001）、校正QT间期（QTc）（458.34±29.71 vs. 393.37±13.21 ms，p<0.001）、T波峰末间期（Tp-e）（85.41±3.52 vs. 71.18±3.16 ms，p<0.001）、Tp-e/QTc比值（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）均有统计学意义的降低。
除了心室复极离散度指标外，HFrEF患者经DAPA治疗后ICEB值的下降表明，DAPA治疗改善了心室去极化和复极化之间的平衡，降低了这些患者发生VA的风险。
