Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been shown to reduce cardiovascular (CV) events such as heart failure hospitalization (HHF) or CV death in different patient populations including those with type 2 diabetes mellitus (T2D), heart failure (HFrEF and HFpEF) or chronic kidney disease. Moreover, these agents reduce the incidence of atrial fibrillation/atrial flutter (AF/AFL) in patients without known AF/AFL irrespective of the presence of diabetes, pre-existing heart failure (HF) or atherosclerotic cardiovascular disease (ASCVD). Functional alterations in the left atrium (LA), particularly changes in left atrial strain (LAS), have been found to predict AF-occurrence and -recurrence but hitherto it remains unexplored whether SGLT2 inhibitor treatment has an impact on LAS. 

Aim: In this subanalysis of the “EMPA Hemodynamics” study of patients with T2D our aim was to investigate effects of empagliflozin treatment on LAS.

Methods: In this placebo‐controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Hemodynamic and echocardiographic parameters, including LAS values, were assessed after 1 day, 3 days and 3 months of treatment. 

Results: Baseline characteristics were not different in the empagliflozin (n = 22) and placebo (n = 20) group. Empagliflozin significantly improved left atrial function after 3 months of treatment as assessed by an increase in left atrial reservoir strain (LASr) and left atrial contraction strain (LASct) values (from 26.4±8.0% to 29.0±7.4%; p=0.011 and from 10.9 ± 5.7% to 12.5 ± 6.0%; p=0.008) compared to placebo. 

Conclusion: In this subanalysis of the “EMPA Hemodynamics” study empagliflozin treatment of patients with T2D significantly improves LA global longitudinal strain after 3 months of treatment.