Empagliflozin may lower AF risk by improving certain parameters of left atrial function
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Key takeaways:
- Empagliflozin conferred improvements in parameters of left atrial function vs. placebo in patients with type 2 diabetes.
- These improvements may ameliorate atrial fibrillation risk.
The antiarrhythmic benefits of empagliflozin in patients with and without diabetes may be explained by the SGLT2 inhibitor’s ability to improve left atrial strain reservoir and contraction phase values, researchers reported.
A post hoc analysis of the EMPA-Hemodynamics study published in Circulation: Cardiovascular Imaging evaluated the underlying mechanism explaining the effect of empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) on risk for atrial fibrillation/atrial flutter in a small cohort of patients with type 2 diabetes.
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“Functional alterations in the left atrium (LA), particularly changes in LA strain (LAS), have been found to predict AF occurrence and recurrence, but hitherto, it remains unexplored whether SGLT2 inhibitors have an impact on [LA strain],” Kirsten Thiele, MD, of the department of internal medicine at University Hospital Aachen, Germany, and colleagues wrote. “Therefore, in this subanalysis of the EMPA Hemodynamics study — a prospective, placebo-controlled, randomized, exploratory study — we examined the effect of empagliflozin on [LA strain] in patients with [type 2 diabetes].”
The post hoc analysis included 44 participants with type 2 diabetes and no AF/atrial flutter randomly assigned to either empagliflozin 10 mg or placebo for 3 months.
Transthoracic echocardiography was used to measure left ventricular ejection fraction and parameters of diastolic function and LA strain was evaluated for the three phases of cycle separately: LA strain reservoir, LA strain conduit and LA strain contraction phase
The researchers reported no effect of empagliflozin on hemodynamic parameters or EF; however, E/e was significantly improved after 1 day of treatment and sustained until the end of the study compared with placebo (P = .038).
Moreover, empagliflozin was associated with improved LA function after 3 months as assessed by a mean increase from 26.4% to 29% in LA strain reservoir (P = .011) and a mean increase from 10.9% to 12.5% in LA strain contraction phase values (P = .008) compared with placebo.
“Our exploratory analysis may provide a potential mechanism to explain the data from several trials and a meta-analysis, suggesting that SGLT2 inhibitors reduce the incidence and recurrence of AF/[atrial flutter] in patients with and without diabetes,” the researchers wrote. “Taken together, our data support that empagliflozin treatment of patients with [type 2 diabetes] ameliorates important structural changes in the heart leading to LA and left ventricular remodeling shown by a significant improvement of [LA strain].”
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