Dapagliflozin Improves LVEF in Non-Diabetic Heart Failure patients: Study

A prospective single-arm observational cohort study published in Cardiology Discovery reports significant echocardiographic improvements and a low rate of mild short‑term adverse events after six months of add‑on dapagliflozin therapy among 53 non‑diabetic Egyptian patients living with heart failure with reduced ejection fraction (HFrEF), filling gaps in regional real‑world evidence for this guideline‑recommended treatment.

Sodium‑glucose co‑transporter‑2 (SGLT2) inhibitor dapagliflozin is guideline‑endorsed for HFrEF regardless of diabetes status. Most pivotal clinical trial data come from multinational cohorts; however, local observational safety and cardiac ultrasound findings for non‑diabetic HFrEF patients in North African clinical practice remain limited. Clinicians in Egypt and similar settings lack region‑specific data to interpret expected cardiac structural changes and tolerability when initiating dapagliflozin for non‑diabetic patients.

This single‑center prospective single‑arm observational cohort enrolled stable, non‑diabetic adult outpatients with HFrEF at Ain Shams University Hospital in Cairo. A total of 55 patients were eligible; two participants were lost to six‑month follow‑up leaving 53 patients for final analysis. All patients received dapagliflozin 10 mg per day added to standard guideline‑directed heart‑failure medications. Serial echocardiograms were completed at baseline, three‑month and six‑month visits, while adverse events were prospectively monitored throughout follow‑up. No placebo or parallel control group was included.

After six months of dapagliflozin treatment, study participants demonstrated statistically significant improvements across all measured left‑ventricular systolic and diastolic echocardiographic markers (all P<0.001). Left‑ventricular ejection fraction rose from baseline 31.0 % ± 3.8 % to 36.6 % ± 4.3 %, corresponding to a 19 % relative increase. Ventricular volumes and diastolic filling markers also showed changes consistent with cardiac reverse remodeling. Mild adverse events occurred in 15 % (8 out of 53) patients: genital mycotic infections in 8 %, urinary‑tract infections in 4 %, and hypoglycemia in 4 %. No symptomatic hypotension was recorded and no participants discontinued dapagliflozin due to side‑effects.

Important study limitations should temper clinical interpretation. The single‑arm uncontrolled design prevents researchers from separating dapagliflozin‑specific effects from improvements driven by background standard‑of‑care therapy; associations observed cannot prove causation. The cohort draws from a single tertiary‑care center in Cairo with modest sample size, limiting generalizability to broader Middle Eastern or African populations. Follow‑up was restricted to six months; the study did not assess long‑term safety nor hard clinical endpoints such as cardiovascular death or heart‑failure hospitalization. Future randomized controlled trials are required to validate these findings and evaluate hard clinical outcomes in comparable patient groups.

Reference:

Ebid, A.-H. I. M., Hanna, M. S., Elserafy, A. S., & Mahmoud, M. A. (2026). Echocardiographic Associations and Short-Term Safety of Dapagliflozin Among Non-Diabetic Egyptian Patients With Heart Failure With Reduced Ejection Fraction: A Prospective Single-Arm Observational Cohort StudyCardiology Discovery https://doi.org/10.1097/CD9.0000000000000205