A Randomised Controlled Trial of Dapagliflozin on Left Ventricular Hypertrophy in People with Type Two Diabetes: The DAPA-LVH Trial

Alexander J. M. Brown, Stephen Gandy, Rory McCrimmon, John Graeme Houston, Allan D. Struthers, Chim C. Lang (Lead / Corresponding author)

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Abstract

Aim: We tested the hypothesis that dapagliflozin may regress left ventricular hypertrophy (LVH) in people with Type 2 diabetes (T2D).

Methods and Results: We randomly assigned 66 people (mean age 67 +/- 7 years, 38 males) with T2D, LVH and controlled blood pressure to receive dapagliflozin 10mg once-daily or placebo for 12 months. Primary endpoint was change in absolute left ventricular mass (LVM), assessed by cardiac magnetic resonance imaging. In the intention to treat analysis (ITTA), dapagliflozin significantly reduced LVM compared to placebo with an absolute mean change of -2.82g (95% confidence interval (CI): -5.13 to -0.51, P= 0.018). Additional sensitivity analysis adjusting for baseline LVM, baseline blood pressure, weight and systolic blood pressure change showed the LVM change to remain statistically significant (mean change -2.92g (95% CI: -5.45 to -0.38, P=0.025)). Dapagliflozin significantly reduced pre-specified secondary end points including ambulatory 24-hour systolic blood pressure (p=0.012), nocturnal systolic blood pressure (p=0.017), body weight (P<0.001), visceral adipose tissue (VAT) (P<0.001), subcutaneous adipose tissue (SCAT) (P=0.001), insulin resistance, HOMA-IR (P=0.017), and high-sensitivity c-reactive protein (hsCRP) (P=0.049).

Conclusion: Dapagliflozin treatment significantly reduced LVM in people with T2D and LVH. This reduction in LVM was accompanied by reductions in systolic blood pressure, body weight, visceral and subcutaneous adipose tissue, insulin resistance and hsCRP. The regression of LVM suggests dapagliflozin can initiate reverse remodelling and changes in left ventricular structure that may partly contribute to the cardioprotective effects of dapagliflozin.
Original languageEnglish
Article numberehaa419
Pages (from-to)1-12
Number of pages12
JournalEuropean Heart Journal
Early online date24 Jun 2020
DOIs
Publication statusE-pub ahead of print - 24 Jun 2020

Keywords

  • Dapagliflozin
  • Heart Failure
  • Left Ventricular Mass
  • Type 2 Diabetes
  • insulin resistance

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