Eastern J Med. 2025; 30(3): 388-396 | DOI: 10.5505/ejm.2025.04378

The effect of empagliflozin on cardiac systolic and diastolic functions in patients with type 2 diabetes mellitus and hypertension

Ahmet Karaduman¹, Cemalettin Yilmaz², Ýsmail Balaban¹, MUSTAFA FERHAT KETEN¹, Semih Kalkan³, Hande Özportakal⁴, Zübeyde Bayram¹, Cem Doðan¹, Ali Karagoz¹, Cihangir Kaymaz¹, Nihal Özdemir^1
1Department of Cardiology, University of Health Sciences, Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, Istanbul, Turkey
²Department of Cardiology, Mus State Hospital, Saltukgazi Neighborhood, Hospital Street, 49400 Malazgirt, Mus, Turkey
³Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
⁴Department of Internal Medicine, University of Health Sciences, Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, Istanbul, Turkey

INTRODUCTION: Empagliflozin may positively affect subclinical left ventricle(LV) dysfunction. We aimed to investigate the effect of empagliflozin on cardiac systolic and diastolic functions in patients with Type 2 diabetes mellitus(DM) and hypertension.
METHODS: Sixty-three patients who underwent transthoracic echocardiography between October-2019 and June-2020, receiving at least one antihypertensive pill, and started empagliflozin treatment due to Type-2 DM were included in the study. Echocardiographic parameters like global longitudinal strain(GLS), left atrial volume index(Lavý), before and 6 months after empagliflozin treatment were compared. Patient's blood pressure(BP),waist circumference, body mass index(BMI), NT-proBNP and other blood parameters were examined.
RESULTS: Of the 63 patients who participated in the study, 30(47.6%) were male. There was an improvement in subclinical cardiac dysfunctions with the use of empagliflozin for 6 months. There was statistically significant difference in GLS (15±2.42 to 16.3±2.3,p<0.001), E/e’ (10[8.5-11],10.5[9-12],p: 0.01), Lavý (29.6±10.5to 27.3±9.8,p<0.001) and NT-proBNP (75,65.7,p<0.001). Significant improvement in GLS was associated with baseline BMI and NT-proBNP elevation. Also, the decrease in Lavý was found to be related to the initial NT-proBNP elevation. In addition, there were significant changes in patients BP(135±7.9,128±6.9,p-<0.001), diastolic BP (80.2±7.2,78.6±6.6,p-value 0.012), waist circumference (107±8.9,104±9.1,p<0.001) and BMI (33.5±5.6;30.2±4.3;p<0.001).
DISCUSSION AND CONCLUSION: Empagliflozin treatment improved subclinical LV systolic and diastolic dysfunctions in patients with Type 2 DM and hypertension. The benefit of Empagliflozin may be associated with weight loss and decrease of NT-pro BNP as this improvement was more prominent in patients with high baseline BMI and NT-proBNP

Keywords: Empagliflozin, global longitudinal strain, Left atrial volume index, sodium glucose co-transporter-2 inhibitor

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