DAPA MODA trial: Dapagliflozin improves multiple parameters of cardiac remodelling

In the prospective DAPA MODA trial, therapy with dapagliflozin reversed left atrium and left ventricle remodelling over 180 days. The therapy also had a positive influence on biomarkers and the quality of life of patients with heart failure (HF).

The mechanisms underlying the positive effect of SGLT2 inhibitors on cardiac remodelling have not yet been fully understood. As the left atrium plays a critical role in cardiac function, Prof. Domingo Pascual-Figal (University Virgen de la Arrixaca, Universidad de Murcia, Spain) and his teams aimed to investigate the impact of dapagliflozin on echocardiographic parameters of cardiac remodelling with special focus on geometry and function of the left atrium [1]. The multicentre, single-arm, open-label, prospective DAPA MODA trial (NCT04707352) was specifically designed to assess the effect of dapagliflozin in cardiac remodelling parameters over a period of 6 months in stable patients with chronic HF irrespective of left ventricular ejection fraction (LVEF) and diabetes status. The primary endpoint was the left atrial volume index (LAVI) maximal change from baseline to 180 days. Secondary endpoints included changes in other parameters of geometry and function of left atrium and left ventricle, and circulation biomarkers.

The 162 participants had a mean age of 70.5 years; 40% were >75 years old. “Our trial population reflects a real-world population in terms of age and long-standing high rates of guideline-directed medical therapy,” Prof. Pascual-Figal commented. Atrial disease was present irrespective of LVEF phenotype. At baseline, the study population had a LAVI maximal of 48,1 ±22.64 ml/m².

At 180 days, therapy with dapagliflozin reduced LAVI maximal by -6.6% (P=0.008). “Therapy with dapagliflozin led to an improvement of all left ventricular remodelling parameters,” Prof. Pascual-Figal said. Left ventricular mass was reduced by 13.9% at 180 days, a highly statistically significant change (P<0.001). The positive treatment effect was mirrored by a reduction of biomarkers: NT-proBNP concentrations were lowered by 18.2% compared with baseline (P<0.001). Therapy with dapagliflozin also improved the quality of life of patients.

Prof. Pascual-Figal concluded that these results support the concept of the left atrium as part of a global adverse remodelling in HF, regardless of LVEF. Part of the benefit of dapagliflozin in HF patients may be explained by the ability to reverse cardiac remodelling.

1. 1. Pascual-Figal DA. DAPA MODA: Dapagliflozin and cardiac remodeling in chronic heart failure. Session Late breaking clinical trials: drugs and devices, Heart Failure 2023, 20– 23 May, Prague, Czechia.

 

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Posted on 25 May, 2023