Observational studyActa diabetologica2026
Dapagliflozin is associated with a reduction in left atrial volume index in type 2 diabetes mellitus without established cardiovascular disease.
Observational study in Acta diabetologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiabetic cardiomyopathy (DCM) frequently begins with diastolic dysfunction (DD), which leads to increased left ventricular filling pressures and subsequent left atrial enlargement, quantified by the left atrial volume index (LAVI). SGLT-2 inhibitors have demonstrated cardioprotective benefits extending beyond glycemic control; however, their specific impact on early cardiac structural remodeling in DCM remains incompletely understood.
methodsThis single-center, prospective observational study enrolled 36 patients with type 2 diabetes mellitus (T2DM) who were initiated on dapagliflozin (10 mg once daily). Thirty-five patients completed 6-month follow-up. Transthoracic echocardiography, exercise ECG testing, and comprehensive laboratory analyses were performed at baseline and at 6 months.
resultsLAVI decreased significantly over 6 months during dapagliflozin treatment (31.7 ± 10.6 vs. 27.9 ± 10.6 ml/m², p < 0.01). Interventricular septum and posterior wall thicknesses were significantly reduced (p < 0.01). Descriptive subgroup patterns were observed: LAVI decrease was statistically significant in asymptomatic patients without clinical heart failure (baseline LAVI < 34 ml/m²), whereas a numerical decrease in the heart failure subgroup did not reach statistical significance; no formal interaction testing was performed. HDL cholesterol increased significantly (46.0 ± 7.4 vs. 48.2 ± 8.1 mg/dL, p = 0.03), while AST and ALT levels declined significantly. Exercise duration and maximum METs improved significantly (p < 0.01). Resting heart rate decreased from 78.0 ± 15.4 to 71.2 ± 13.3 bpm (p < 0.01).
conclusionLAVI was significantly lower at 6 months compared to baseline in T2DM patients during dapagliflozin treatment, consistent with a possible association with early structural changes in diabetic cardiomyopathy. Given the uncontrolled, single-arm design, causality cannot be inferred; these findings are hypothesis-generating and require confirmation in randomized controlled studies. Secondary exploratory findings, including improved exercise capacity, reduced resting heart rate, raised HDL cholesterol, and improved hepatic enzyme profiles, should likewise be interpreted with caution.
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