Left Ventricle Global Longitudinal Strain Based Heart Failure Assessment in "At Risk" Patients with Type 2 Diabetes Mellitus
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Type 2 diabetes mellitus (T2DM) is a growing global health burden and is strongly associated with cardiovascular disease, particularly heart failure. The risk of heart failure in diabetic patients is approximately four times higher than in the general population, often due to metabolic, structural, and hemodynamic alterations. Conventional echocardiographic markers such as left ventricular ejection fraction (LVEF) may remain normal in early disease, limiting their ability to detect subclinical dysfunction. Global longitudinal strain (GLS), measured by speckle-tracking echocardiography, is a sensitive parameter for identifying early myocardial dysfunction. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated cardiovascular benefits in large-scale clinical trials, but most evidence involves patients with established cardiovascular disease. The present study was undertaken to assess the effect of dapagliflozin on GLS in asymptomatic T2DM patients with preserved LVEF. Objectives: · To assess baseline left ventricular systolic function using GLS in T2DM patients without symptomatic heart failure. · To evaluate the impact of dapagliflozin on changes in GLS after 8 weeks of therapy compared to placebo. Methods: This open-label randomized controlled trial was conducted at LLR & Associated Hospitals, Kanpur, from December 2022 to December 2024. A total of 267 diabetic patients were screened; 171 without symptoms of heart failure were randomized into placebo (n=86) and intervention groups (n=85). After attrition, 156 patients (78 per group) completed the study. The intervention group received dapagliflozin 10 mg daily in addition to standard care, while the placebo group continued standard treatment. Baseline GLS was measured using 2D speckle-tracking echocardiography and reassessed at 8 weeks. Clinical, biochemical, and echocardiographic parameters were compared between groups using appropriate statistical methods. Results: At baseline, both groups had similar GLS values (mean GLS: -15.54 in intervention vs. -15.37 in placebo; p=0.242). After 8 weeks, the intervention group demonstrated significant improvement in GLS (-16.81 ± 2.09), while the placebo group showed no meaningful change (-15.29 ± 2.04; p < 0.001). A higher proportion of patients in the intervention group achieved normalization of GLS (65.38%) compared to the placebo group (17.94%). Conversely, deterioration of GLS (< -14) was more frequent in the placebo group (28.2%) than in the intervention group (12.82%). Other metabolic and renal parameters remained broadly comparable. Conclusion: Dapagliflozin significantly improved GLS in T2DM patients without symptomatic heart failure, indicating its role in preventing progression to overt cardiac dysfunction. GLS proved to be a sensitive marker for early myocardial changes, supporting its routine use in diabetic populations. SGLT-2 inhibitors may thus offer dual metabolic and cardioprotective benefits even in asymptomatic patients.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7117695086
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