Effects of Liraglutide, Empagliflozin and Their Combination on Left Atrial Strain and Arterial Function
<i>Background and Objectives</i>: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are cardioprotective drugs. We investigated their effects on left atrial function, a major determinant of cardiac diastolic dysfunction in type 2...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-02-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/60/3/395 |
| Summary: | <i>Background and Objectives</i>: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are cardioprotective drugs. We investigated their effects on left atrial function, a major determinant of cardiac diastolic dysfunction in type 2 diabetes mellitus. We also explored the association of changes in arterial stiffness with those of the LA strain after treatment. <i>Materials and Methods</i>: A total of 200 patients (59.5 ± 9.1 year old, 151 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n = 50 served as controls), liraglutide (n = 50), empagliflozin (n = 50) or their combination (liraglutide + empagliflozin) (n = 50). We measured at baseline and 6 months post-treatment: (a) left atrial and global left ventricular longitudinal strain by speckle tracking echocardiography; (b) pulse wave velocity (PWV) and central systolic blood pressure. <i>Results</i>: At baseline, there was a correlation of the LA reservoir strain with PWV (r = −0.209, <i>p</i> = 0.008), central SBP (r = −0.151, <i>p</i> = 0.030), EF (r = 0.214, <i>p</i> = 0.004) and GLS (r = −0.279, <i>p</i> = 0.009). The LA reservoir change 6 months post-treatment was correlated with the PWV change in all groups (r = −0.242, <i>p</i> = 0.028). The LA reservoir change 6 months post-treatment was correlated with the GLS change in all groups (r = −0.322, <i>p</i> = 0.004). Six months after intervention, patients treated with liraglutide, empagliflozin and their combination improved the left atrial reservoir strain (GLP1RA 30.7 ± 9.3 vs. 33.9 ± 9.7%, <i>p</i> = 0.011, SGLT2i 30 ± 8.3 vs. 32.3 ± 7.3%, <i>p</i> = 0.04, GLP1&SGLT2i 29.1 ± 8.7 vs. 31.3 ± 8.2, <i>p</i> = 0.007) compared to those treated with insulin (33 ± 8.3% vs. 32.8 ± 7.4, <i>p</i> = 0.829). Also, patients treated with liraglutide and the combination liraglutide and empagliflozin had improved left atrial conduction strain (<i>p</i> < 0.05). Empagliflozin or the combination liraglutide and empagliflozin showed a greater decrease of PWV and central and brachial systolic blood pressure than insulin or GLP-1RA. (<i>p</i> < 0.05). <i>Conclusions</i>: Impaired aortic elastic properties are associated with a decreased LA strain in type 2 diabetics. Treatment with liraglutide, empagliflozin and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with the improvement of arterial and myocardial functions. |
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| ISSN: | 1010-660X 1648-9144 |