Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Oltean, S.
The Impact of the SGLT2 Inhibitor Empagliflozin on
Right Atrial Function after Acute Myocardial Infarction
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 72
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Benedikt Martin
- von Lewinski Dirk
- Altmetrics:
- Abstract:
- Background and Purpose: Myocardial infarction is one of the leading causes of death in industrialised countries. Myocardial damage due to ischaemia and reperfusion leads to the activation of maladaptive remodelling processes and neurohumoral changes and subsequently to the development of heart failure. The EMMY trial (“Empagliflozin in acute myocardial infarction: the EMMY trial“) was the first to show that the early use of empagliflozin after acute myocardial infarction leads to a significant improvement in NT-proBNP and functional and structural echocardiographic parameters. The data on the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors after acute myocardial infarction is currently limited. In this sub-analysis of the EMMY trial, the effect of empagliflozin on the right atrium will be investigated. Right atrial function correlates with the severity of heart failure and is a prognostic marker. To date, no study has performed a systematic echocardiographic evaluation of the right atrium after acute myocardial infarction and treatment with empagliflozin. Material and Methods: A total of 206 subjects from the patient population of the EMMY trial, which took place from the 11th of May 2017 to the 3rd of May 2022, were used for the analysis. The primary outcome was the change in right atrial global longitudinal strain (GLS) over a period of 26 weeks. Secondary outcomes include changes in the right atrial dimensions and volumes, right atrial ejection fraction (RAEF) and systolic pulmonary artery pressure (sPAP). In addition, correlations between the individual echo parameters, as well as NT-proBNP, creatine kinase (CK) and high-sensitivity troponin were investigated. The evaluation of the echocardiography loops was performed using the software TomTec (TOMTEC Imaging Systems, Munich, Germany) and for the statistical analysis, IBM SPSS statistics 26 (IBM Corporation, Armonk/New York, US) was used. Results: The right atrial GLS in the empagliflozin group showed no significant change at the third measurement time point compared to the placebo group (p = 0.149). Within the male subgroup, the significance threshold was barely missed (empagliflozin: 35.6 ± 11.3%, placebo: 32.7 ± 8%, p = 0.056). The right atrial end-diastolic volume (EDV) within the male subgroup was significantly reduced (empagliflozin: 29.6 ± 13.7 ml, placebo: 32.6 ± 12.9 ml, p = 0.021). Furthermore, the mean values of the right atrial parameters GLS, sPAP, right atrial volume index (RAVI) and end-systolic (ESV) and end-diastolic volume (EDV) were already improved in the empagliflozin group after 6 weeks compared to the control group. In addition, the right atrial GLS shows a significant correlation with all other regular right atrial echocardiographic parameters and NT-proBNP, especially at the third measurement time point. Conclusion: Early administration of empagliflozin after acute myocardial infarction significantly improves right atrial EDV in male subjects (p = 0.021). The right atrial GLS within the males showed almost significant results (p = 0.056). However, no significant results could be achieved when all study participants were included. Right atrial GLS correlates significantly with right atrial structural and functional echocardiographic parameters and NT-proBNP, especially in patients with chronic heart failure.