Dapagliflozin improves LAVI, LV mass, and concentration of natriuretic peptides after 6 months

The results of the prospective DAPA MODA trial suggest that dapagliflozin may have the ability to reverse cardiac remodelling over 180 days in patients with heart failure (HF). Therapy was also associated with improved biomarkers and the quality of life of patients.

Dapagliflozin improves the prognosis of patients across all ranges of left ventricular ejection fraction by preventing HF decompensations and cardiovascular deaths. However, mechanisms underlying the clinical benefit, in particular 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 of Murcia, Spain) and his team investigated the impact of dapagliflozin on echocardiographic parameters of cardiac remodelling with a special focus on geometry and function of the left atrium [1].

The multicentre, single-arm, open-label, prospective DAPA MODA trial (NCT04707352) was 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, the function of the left atrium and left ventricle and circulation biomarkers.

The 162 participants had a mean age of 70.5 years, and 40% were over 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 was associated with a lower LAVI maximal by 6.6% (P=0.008) relative to baseline. “Therapy with dapagliflozin led to an improvement of all left ventricular remodelling parameters,” Prof. Pascual-Figal said. Left ventricular mass was observed to be lower by 13.9% at 180 days (p<0.001). The positive changes were mirrored by lower biomarkers: NT-proBNP concentrations 18.2% compared with baseline (P<0.001). Therapy with dapagliflozin also improved the quality of life of participants.

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. 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 8 August 202328 March 2024