The mechanisms underlying the positive effect of SGLT2 inhibitors on cardiac remodeling have not yet been fully understood. As the left atrium plays a critical role in cardiac function, Dr. Domingo Pascual-Figal and his team aimed to investigate the impact of dapagliflozin on echocardiographic parameters of cardiac remodeling, with special focus on geometry and function of the left atrium. The multicenter, single-arm, open-label, prospective DAPA MODA trial (NCT04707352) was specifically designed to assess the effect of dapagliflozin in cardiac remodeling parameters over a 6-month period 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 or older. “Our trial population reflects a real-world population in terms of age and long-standing high rates of guideline-directed medical therapy,” Dr. 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 remodeling parameters,” Dr. 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.

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

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