Impact of diabetes duration on left ventricular mass regression with empagliflozin

• Type of Material: Article
• Authors: Michael Moroney, St. Michael's Hospital of Unity Health Toronto; Raj Verma, St. Michael's Hospital of Unity Health Toronto; Makoto Hibino, Emory University; David C Mazer, St. Michael's Hospital of Unity Health Toronto; Kim A Connelly, St. Michael's Hospital, Toronto Ontario; Andrew T Yan, University of Toronto; Adrian Quan, St. Michael's Hospital of Unity Health Toronto; Hwee Teoh, St. Michael's Hospital of Unity Health Toronto; Subodh Verma, St. Michael's Hospital of Unity Health Toronto; Pankaj Puar, St. Michael's Hospital of Unity Health Toronto
• Language: English
• Date: 2023-04-10
• Publisher: WILEY PERIODICALS, INC
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/ehf2.14357
• Title of Journal or Parent Work: ESC HEART FAILURE
• Volume: 10
• Issue: 3
• Start Page: 2134
• End Page: 2140
• Grant/Funding Information: The conduct of the EMPA‐HEART CardioLink‐6 trial was supported by an unrestricted investigator‐initiated study grant from Boehringer Ingelheim.
• Keywords: Diabetes; SGLT2 inhibitor; Diabetes severity; Science & Technology; Life Sciences & Biomedicine; ASSOCIATION; MELLITUS; Left ventricular reverse remodelling; Diabetes duration; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; CARDIOVASCULAR OUTCOMES; RISK
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Aims: The duration of type 2 diabetes mellitus (T2DM) is an important determinant of diabetes severity. The EMPA-HEART CardioLink-6 trial reported significant left ventricular (LV) mass indexed to body surface area (LVMi) regression in patients treated with the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin for 6 months. This exploratory sub-analysis of the same trial investigated the association between T2DM duration and LVMi regression. Methods and results: A total of 97 individuals with T2DM and coronary artery disease (CAD) were randomly assigned to receive empagliflozin 10 mg daily or placebo. LVMi was measured at the baseline and 6 month visit using cardiac magnetic resonance imaging. The study population was divided into those with a baseline T2DM duration <10 years (n = 40) or ≥10 years (n = 57). A linear model adjusting for baseline values in each of the subgroups (ANCOVA) was used to assess the treatment effect of 6 month change in LVMi, LV end systolic volume indexed to body surface area, LV end diastolic volume indexed to body surface area and LV ejection fraction. Patients in the T2DM duration <10 years group (38 males [95.0%], median age 63 [IQR: 55 years to 70 years]) had a median T2DM duration of 4 years (IQR: 2.0 years to 7.0 years). Those in the T2DM duration ≥10 years group (52 males [91.2%], median age 65 [IQR: 57 years to 71 years]) had a median duration of 15 years (IQR: 12 years to 20 years). There was no significant difference in baseline LVMi according to T2DM duration (median 62 g/m2 [IQR: 53.1 g/m2 to 70.0 g/m2] for T2DM duration <10 years; median 57.5 g/m2 [IQR: 52.1 g/m2 to 66.2 g/m2] for T2DM duration ≥10 years; P = 0.11). Empagliflozin was associated with reductions in LVMi irrespective of duration of T2DM above and below 10 years (T2DM duration <10 years group, mean adjusted difference −2.90 g/m2 [95% CI: −6.64 g/m2 to 0.84 g/m2]; T2DM duration ≥10 years group, mean adjusted difference −3.69 g/m2 [95% CI: −0.14 g/m2 to −7.24 g/m2]; Pinteraction = 0.07). Conclusions: In the EMPA-HEART CardioLink-6 trial, empagliflozin treatment was associated with reductions in LVMi in people with T2DM and CAD irrespective of the duration of diabetes assessed categorically above and below 10 years.