Left ventricular mass predicts cardiac reverse remodelling in patients treated with empagliflozin

Left ventricular hypertrophy (LVH) is an established predictor of poor cardiovascular outcomes, while increases in left ventricular mass indexed (LVMi) have been independently associated with all-cause mortality and sudden death. Sodium-glucose transport protein 2 inhibitors (SGLT2i) have shown marked cardiovascular and renal benefits in patients with type 2 diabetes (T2D).

The EMPA-HEART CardioLink-6 study investigated that sodium-glucose cotransporter-2 inhibition for 6 months with empagliflozin was associated with a significant reduction in LVMi. In this sub-analysis, the study published in Cardiovascular Diabetology evaluated whether baseline LVMi may influence how empagliflozin affects cardiac reverse remodelling.

A total of 97 patients with type 2 diabetes and coronary artery disease were randomized to empagliflozin (10 mg/d) or matching placebo for 6 months. The study cohort was divided into those whose baseline LVMi was ≤ 60 g/m2 and those who had a baseline LVMi > 60 g/m2. Subgroup comparisons were conducted using a linear regression model adjusted for baseline values (ANCOVA) that included an interaction term between LVMi subgroup and treatment.

The key findings of the study are

• Baseline LVMi was 53.3 g/m2 (49.2–57.2) and 69.7 g/m2 (64.2–76.1) for those with baseline ≤ 60 g/m2 (n = 54) and LVMi > 60 g/m2 (n = 43) respectively.

• The adjusted difference of LVMi regression between those randomized to empagliflozin and placebo were − 0.46 g/m2 (95% CI: −3.44, 2.52, p = 0.76) in the baseline LVMi ≤ 60 g/m2 subgroup and − 7.26 g/m2 (95% CI: −11.40, −3.12, p = 0.0011) in the baseline LVMi > 60 g/m2 subgroup (p-for-interaction = 0.007).

• No significant associations were found between baseline LVMi and 6-month change in LV end systolic volume-indexed (p-for-interaction = 0.086), LV end diastolic volume-indexed (p-for-interaction = 0.34), or LV ejection fraction (p-for-interaction = 0.15).

Pankaj Puar said “Patients with higher LVMi at baseline experienced greater LVM regression with empagliflozin.” In conclusion, patients with larger LVMi at baseline experienced significantly greater cardiac reverse remodelling with empagliflozin than patients with a lower LVMi at baseline.

Reference: Puar, P., Hibino, M., Mazer, C.D. et al. Left ventricular mass predicts cardiac reverse remodelling in patients treated with empagliflozin. Cardiovasc Diabetol 22, 152 (2023). https://doi.org/10.1186/s12933-023-01849-w