Oral Abstract

Oral Abstract Clinical #2- World Impact of Cardiac MRI in Cardiovascular Disease Management

Longitudinal Diastolic Strain Rate Increase as Marker of Improved Relaxation in Patients with Type 2 Diabetes Without Known Heart Failure after Treatment with SGLT2 Inhibitors

Friday, January 31, 2025

11:20 AM – 11:30 AM East Coast USA Time

Location: Diplomat Ballroom

Presenting Author(s)

AN

Anna V. Naumova, PhD

Research Associate Professor
University of Washington

Primary Author(s)

AN

Anna V. Naumova, PhD

Research Associate Professor
University of Washington

Co-Author(s)

NB

Niranjan Balu, PhD

Research Associate Professor
University of Washington
FK

Francis Kim, MD

Professor
University of Washington
Karen Ordovas, MD, FSCMR

Professor of Radiology
University of Washington

Background: Sodium glucose co-transporter 2 inhibitors (SGLT2-i) are beneficial for diabetic patients due to reduction of plasma glucose as well as improvement of cardiovascular outcomes [1]. The positive effect of SGLT2-i on the heart might be mediated via decrease of cardiac inflammation and fibrosis. Cardiac fibrosis is known to adversely affect diastolic function [2]. Non-invasive assessment of myocardial tissue characteristics and regional diastolic function reflects the presence of inflammation and fibrosis. To monitor these changes, we conducted cardiac magnetic resonance (CMR) imaging study in type-2 diabetic patients without known heart disease before and one year after treatment with SGLT2-i.

Methods: 56 adult patients with type-2 diabetes were randomized to 12 months of daily 10 mg SGLT2-i or placebo. CMR examination was done at a 3T scanner (Ingenia, Phillips) at the time of enrollment (baseline) and at one-year follow up. CMR protocol included steady state free precession (SSFP) cine imaging to assess left ventricular (LV) morphology and function, T1-, T2-, and T2*-mapping. Cardiac fibrosis was assessed by calculation of extracellular volume fraction (ECV). Global and regional myocardial strain and strain rate were assessed from cine SSFP images using feature tracking CMR techniques in Circle Cardiovascular Imaging (cvi-42) software.

Results: Mean age of the patients was 64 ± 9 years; mean BMI 30 ± 5 (88% overweight, BMI≥25); 61% males. No differences were noted in the baseline characteristics between the SGLT2-i and placebo groups, therefore, baseline results were combined. One year treatment of the diabetic patients with SGLT2-i did not change myocardial tissue characteristics (T1, T2, T2*, ECV) and global contractility (LV chamber volumes, stroke volume, cardiac output and ejection fraction (Table 1). However, there was an increase in global and regional longitudinal diastolic strain rate after one year of SGLT2-i treatment and decrease in this parameter in the placebo group (Table 2). Therefore, the mechanism of SGLT2-i action might be related to improvement of diastolic function.

Conclusion: This study demonstrates that 12 months of SGLT2-i treatment of type-2 diabetic patients does not alter global contractility of their hearts and myocardial tissue characteristics, but the treatment increased longitudinal myocardial diastolic strain rate in comparison with the placebo group. Early fibrosis is thought to primarily affect relaxation, so improvement in relaxation in the treatment group might serve as an imaging biomarker for protection against fibrosis development. The length of observation might not be sufficient to detect the structural changes in myocardial tissue inflammation and fibrosis.