Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis
Introduction: Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucos...
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| Format: | Article |
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MDPI AG
2023-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/1/16 |
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| author | Razan Al Namat Letiția Doina Duceac Liliana Chelaru Marius Gabriel Dabija Cristian Guțu Constantin Marcu Maria Valentina Popa Florina Popa Elena Roxana Bogdan Goroftei Elena Țarcă |
| author_facet | Razan Al Namat Letiția Doina Duceac Liliana Chelaru Marius Gabriel Dabija Cristian Guțu Constantin Marcu Maria Valentina Popa Florina Popa Elena Roxana Bogdan Goroftei Elena Țarcă |
| author_sort | Razan Al Namat |
| collection | DOAJ |
| description | Introduction: Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. Aim: Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. Materials and Methods: One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM−CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD−CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. Results: One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, <i>p</i> < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (<i>p</i> = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (<i>p</i> = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, <i>p</i> = 0.000) and in patients without T2DM (by 73,294 ng/L, <i>p</i> = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, <i>p</i> = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (<i>p</i> = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01–6.08% (<i>p</i> = 0.000), T2DM−CKD 7.08–6.04% (<i>p</i> = 0.000), PreD+CKD 5.66–4.98% (<i>p</i> = 0.014), and PreD−CKD 6.03–4.94% (<i>p</i> = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15–87.07%, <i>p</i> = 0.000) in the presence of established diabetes and 14.89 (64.75–79.64%, <i>p</i> = 0.000) in the prediabetes group. Conclusions: Regarding the patients’ cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation. |
| first_indexed | 2024-03-08T15:09:49Z |
| format | Article |
| id | doaj.art-d58508547d684fb4a621d84dd30bbaea |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-08T15:09:49Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-d58508547d684fb4a621d84dd30bbaea2024-01-10T14:53:37ZengMDPI AGDiagnostics2075-44182023-12-011411610.3390/diagnostics14010016Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience AnalysisRazan Al Namat0Letiția Doina Duceac1Liliana Chelaru2Marius Gabriel Dabija3Cristian Guțu4Constantin Marcu5Maria Valentina Popa6Florina Popa7Elena Roxana Bogdan Goroftei8Elena Țarcă9Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, RomaniaFaculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, RomaniaFaculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, RomaniaFaculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, RomaniaFaculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, RomaniaFaculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, RomaniaFaculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, RomaniaFaculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, RomaniaFaculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, RomaniaDepartment of Surgery II—Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, RomaniaIntroduction: Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. Aim: Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. Materials and Methods: One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM−CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD−CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. Results: One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, <i>p</i> < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (<i>p</i> = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (<i>p</i> = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, <i>p</i> = 0.000) and in patients without T2DM (by 73,294 ng/L, <i>p</i> = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, <i>p</i> = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (<i>p</i> = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01–6.08% (<i>p</i> = 0.000), T2DM−CKD 7.08–6.04% (<i>p</i> = 0.000), PreD+CKD 5.66–4.98% (<i>p</i> = 0.014), and PreD−CKD 6.03–4.94% (<i>p</i> = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15–87.07%, <i>p</i> = 0.000) in the presence of established diabetes and 14.89 (64.75–79.64%, <i>p</i> = 0.000) in the prediabetes group. Conclusions: Regarding the patients’ cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation.https://www.mdpi.com/2075-4418/14/1/16CABGheart failureSGLT2 inhibitorstype-2 diabetes mellitusH-FABP |
| spellingShingle | Razan Al Namat Letiția Doina Duceac Liliana Chelaru Marius Gabriel Dabija Cristian Guțu Constantin Marcu Maria Valentina Popa Florina Popa Elena Roxana Bogdan Goroftei Elena Țarcă Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis Diagnostics CABG heart failure SGLT2 inhibitors type-2 diabetes mellitus H-FABP |
| title | Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis |
| title_full | Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis |
| title_fullStr | Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis |
| title_full_unstemmed | Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis |
| title_short | Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis |
| title_sort | post coronary artery bypass grafting outcomes of patients with without type 2 diabetes mellitus and chronic kidney disease treated with sglt2 inhibitor dapagliflozin a single center experience analysis |
| topic | CABG heart failure SGLT2 inhibitors type-2 diabetes mellitus H-FABP |
| url | https://www.mdpi.com/2075-4418/14/1/16 |
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