Background:

The improving and prognostic relevant effect of SGLT-2 inhibitors in patients with HFrEF has been previously shown. Since 2021, SGLT-2 inhibitors are recommended as a class 1 in the current guidelines. In this study, we aimed to evaluate the effect of SGLT-2 inhibitors on left ventricular strain in patients with HFrEF. 

Methods:

We retrospectively included 100 patients with HFrEF. All patients underwent comprehensive echocardiography inclusively blood tests before and 12 months after the inclusion.

The echocardiographic images were analyzed using an offline workflow of dedicated software (TomTec Image Arena, 4D LV-Analysis, Munich, Germany) to assess left ventricular strain analysis. The images from apical four-, two- and three-chamber views were used for the analyses. Left ventricular endocardium border was semiautomatically tracked (BeutelTM) as a region of interest. In the case of suboptimal alignment, a manual adjustment was performed. Endocardium borders were automatically approved during end-diastole and end-systole. After that, the offline measurements from volumetric and strain analysis were automatically shown.

Results:

100 patients (64 ± 15.21 years, 24.1 % female) with HFrEF (LVEF: 31.72 ± 9.1 %) were randomly selected. There were no relevant valvular diseases at baseline. All patients were under optimal guidelines directed medical heart failure therapy and the therapies were comparable between groups at baseline as well as at follow-up. 

After 12 months, we found significantly improved left ventricular function assessed by left ventricular ejection fraction (A4C: 31.72 % to 35.80%, p<0.05; A2C: 33.29% to 36.80%, p<0.05; A3C: 30.81% to 34.93%, p<0.05) and left ventricular global longitudinal strain (A4C: -9.19% to -10.75%, p<0.05; A2C: -9.97% to -11.40%, p<0.05; A3C: -8,41% to -10.84, p<0.05).

No major events (mortality or hospital readmission due to cardiac decompensation) occurred during the follow-up.

Conclusion:

SGLT-2 inhibitors significantly improve not only the left ventricular function (13%) but also the left ventricular global longitudinal strain (18%) in patients with HFrEF 12 months after the admission.