Effect of dapagliflozin on left ventricular longitudinal strain and atrioventricular coupling in heart failure with preserved ejection fraction and chronic kidney disease
- 1Department of Ultrasound, The First Hospital of Jiaxing/Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province 314001 China
- 2Department of Cardiology, The First Hospital of Jiaxing/Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province 314001 China
- 3Department of Cardiology, Guanghan Hospital of Traditional Chinese Medicine, Deyang City, Sichuan Province 618300 China
Abstract
Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i), including dapagliflozin, were initially developed for type 2 diabetes mellitus. Despite the established benefits of SGLT2i in heart failure (HF) with preserved ejection fraction (HFpEF), their effects on myocardial deformation (assessed by global longitudinal strain, GLS) and left atrioventricular coupling (quantified by the left atrioventricular coupling index, LACI) in HFpEF patients with concomitant chronic kidney disease (CKD)—hereafter referred to as HFpEF-CKD—remain unclear. This study aimed to evaluate the effects of dapagliflozin on GLS and LACI in this high-risk comorbid population.
Methods: This prospective cohort study enrolled 259 patients with HFpEF-CKD from September 2023 to October 2024. Participants were assigned to two groups: the dapagliflozin group (dapagliflozin 10 mg/day added to conventional HF and CKD therapy without SGLT2i, n = 138) and the control group (conventional HF and CKD therapy without SGLT2i, n = 121).
Conventional and speckle-tracking echocardiography were performed at baseline and 6-month follow-up to assess GLS, LACI, left ventricular ejection fraction (LVEF) and left atrial volume (LAV) parameters, including minimal LAV (LAVmin) and LAV index (LAVI).
Results: Compared with controls, dapagliflozin decreased GLS (between-group Δ: -1.34%, 95% CI: -1.72 to -0.97; Cohen’s d = 0.875) and reduced LACI (Δ: -0.07, 95% CI: -0.09 to -0.05; Cohen’s d = 0.855), both p < 0.001. The dapagliflozin group showed greater reductions in LAV parameters (ΔLAVmin: -6.38 ± 9.06 mL vs. -1.25 ± 3.78 mL, p < 0.001; ΔLAVI: -0.82 ± 1.79 mL/m² vs. -0.43 ± 1.57 mL/m², p = 0.075). LVEF remained stable in both groups (p = 0.264).
Multivariable regression analysis confirmed dapagliflozin as an independent predictor for both GLS reduction (B = -1.335, 95% CI: -1.686 to -1.006, p < 0.001) and LACI reduction (B = -0.057, 95% CI: -0.074 to -0.040, p < 0.001).
Conclusions: In patients with HFpEF-CKD, dapagliflozin improves left ventricular longitudinal function and atrioventricular coupling. The superior sensitivity of novel echocardiographic parameters—GLS, LACI, and LAVmin—supports their clinical utility for monitoring early cardiac functional recovery during treatment.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06362-y.
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BibTeX
@article{chen2026effect,
title = {{Effect of dapagliflozin on left ventricular longitudinal strain and atrioventricular coupling in heart failure with preserved ejection fraction and chronic kidney disease}},
author = {Fei Chen and Chenyue Xu and Yujia Chen and Cong Li and Yunyun Yi and Chaohui Weng and Juan Zhou and Chaojie He and Guo Ji},
journal = {BMC Cardiovascular Disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06362-y},
url = {https://doi.org/10.1186/s12872-026-06362-y},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Effect of dapagliflozin on left ventricular longitudinal strain and atrioventricular coupling in heart failure with preserved ejection fraction and chronic kidney disease
AU - Fei Chen
AU - Chenyue Xu
AU - Yujia Chen
AU - Cong Li
AU - Yunyun Yi
AU - Chaohui Weng
AU - Juan Zhou
AU - Chaojie He
AU - Guo Ji
PY - 2026
DA - 2026/07/30
JO - BMC Cardiovascular Disorders
DO - 10.1186/s12872-026-06362-y
UR - https://doi.org/10.1186/s12872-026-06362-y
AB - Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i), including dapagliflozin, were initially developed for type 2 diabetes mellitus. Despite the established benefits of SGLT2i in heart failure (HF) with preserved ejection fraction (HFpEF), their effects on myocardial deformation (assessed by global longitudinal strain, GLS) and left atrioventricular coupling (quantified by the left atrioventricular coupling index, LACI) in HFpEF patients with concomitant chronic kidney disease (CKD)—hereafter referred to as HFpEF-CKD—remain unclear. This study aimed to evaluate the effects of dapagliflozin on GLS and LACI in this high-risk comorbid population. Methods: This prospective cohort study enrolled 259 patients with HFpEF-CKD from September 2023 to October 2024. Participants were assigned to two groups: the dapagliflozin group (dapagliflozin 10 mg/day added to conventional HF and CKD therapy without SGLT2i, n = 138) and the control group (conventional HF and CKD therapy without SGLT2i, n = 121). Conventional and speckle-tracking echocardiography were performed at baseline and 6-month follow-up to assess GLS, LACI, left ventricular ejection fraction (LVEF) and left atrial volume (LAV) parameters, including minimal LAV (LAVmin) and LAV index (LAVI). Results: Compared with controls, dapagliflozin decreased GLS (between-group Δ: -1.34%, 95% CI: -1.72 to -0.97; Cohen’s d = 0.875) and reduced LACI (Δ: -0.07, 95% CI: -0.09 to -0.05; Cohen’s d = 0.855), both p < 0.001. The dapagliflozin group showed greater reductions in LAV parameters (ΔLAVmin: -6.38 ± 9.06 mL vs. -1.25 ± 3.78 mL, p < 0.001; ΔLAVI: -0.82 ± 1.79 mL/m² vs. -0.43 ± 1.57 mL/m², p = 0.075). LVEF remained stable in both groups (p = 0.264). Multivariable regression analysis confirmed dapagliflozin as an independent predictor for both GLS reduction (B = -1.335, 95% CI: -1.686 to -1.006, p < 0.001) and LACI reduction (B = -0.057, 95% CI: -0.074 to -0.040, p < 0.001). Conclusions: In patients with HFpEF-CKD, dapagliflozin improves left ventricular longitudinal function and atrioventricular coupling. The superior sensitivity of novel echocardiographic parameters—GLS, LACI, and LAVmin—supports their clinical utility for monitoring early cardiac functional recovery during treatment. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06362-y.
SN - 1471-2261
ER -