Impact of Empagliflozin on Left Ventricular Mechanics using 3-D Echocardiography in Heart Failure Patients with Reduced Ejection Fraction

Abstract

Background: Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated notable clinical benefits in cases with heart failure with reduced ejection fraction (HFrEF), irrespective of diabetic status. However, underlying impacts of empagliflozin on myocardial systolic mechanics, particularly at the myocardial level, remain incompletely understood.

Method: This prospective cohort study that included non-diabetic patients with HFrEF (left ventricular ejection fraction (LVEF) ≤40%) who were naïve to empagliflozin therapy and have been on optimal guidelines directed medical treatment for a minimum of 6 months. All patients were evaluated at baseline and after 6 months from the initiation of empagliflozin. Conventional, three-dimensional, and speckle-tracking echocardiography were used to evaluate left ventricular volumes, ejection fraction, myocardial strain parameters (GLS, GCS, GAS, and GRS), and structural remodeling. Functional status was assessed using NYHA classification and the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Result: A total of 150 non-diabetic patients with HFrEF were included in the study, with a mean age of 56.6 ± 9.7 years, 36% were female. After 6 months of empagliflozin therapy, patients demonstrated a significant improvement in left ventricular systolic function, with a marked increase in LVEF and significant reductions in left ventricular end-diastolic and end-systolic volumes (p < 0.001). In addition, significant improvements were also observed in myocardial deformation parameters, including GLS, GCS, GAS, and GRS (all p < 0.001). Additionally, LV mass index, left atrial volume index, and pulmonary artery systolic pressure significantly decreased. Functional capacity improved markedly, with reduction in NYHA class and significant increase in KCCQ score (p < 0.001).

Conclusion: These results support the myocardial-level benefits of empagliflozin beyond glycemic control and reinforce its role as a cornerstone therapy in HFrEF irrespective of diabetic status.