Effect of Sodium Glucose Cotransporter 2 Inhibitor on Left Ventricular Mechanics in Heart Failure Patients with Preserved Ejection Fraction (Speckle Tracking Imaging Study)

Background: Heart failure with preserved ejection fraction (HFPEF) is a common form of heart failure with limited treatment options. Sodium glucose cotransporter 2 (SGLT2) inhibitors have shown cardiovascular benefits, but their impact on left ventricular function in HFPEF remains unclear. Speckle tracking imaging may clarify their effects on myocardial mechanics.
Objective: This study aimed to evaluate the impact of SGLT 2 inhibitors on left ventricular (LV) mechanics in heart failure (HF) patients with preserved ejection fraction (EF), as assessed via 2D speckle tracking echocardiography.
Methods: 40 patients above the age of 18 years with symptoms and signs of HF with left ventricular EF (LVEF) ≥50% (HFPEF) were involved in prospective cohort observational analytical research at The Department of Cardiology, Menoufia University Hospital's Echocardiography Clinic, through the period from July 2024 to March 2025. There were 2 subgroups divided into 24 patients with sinus rhythm and 16 patients with atrial fibrillation. They were subjected to history taking, clinical examination, and 12-lead ECG, complete 2D conventional echo (including M-mode and Doppler) and 2D speckle tracking. Strain (circumferential, longitudinal, and radial) was activated by using at least three cardiac cycles captured in cine format in the form of apical 4, 3, and 2 chamber views, as well as short-axis views at the mitral valve and papillary muscle levels. Echo examination was done before initiation of sodium-glucose co-transporter-2 inhibitors and after 2 months of drug adherence.
Results: Improvement of symptomatology as detected by improvement of New York Heart Association (NYHA) class, heart rate, control of AF, correction of diastolic dysfunction, improvement of conventional echocardiographic parameters, and speckle tracking-derived indices.
Conclusion: Improved left ventricular mechanics in the form of improvement of diastolic function and speckle tracking parameters such as global longitudinal, radial, and circumferential strain, and it is reflected as improvement of NYHA class.