Влияние дапаглифлозина на динамику показателей магнитно-резонансной томографии у пациентов с сердечной недостаточностью и фибрилляцией предсердий

Сайпудинова К.М., Ускач Т.М., Шария М.А., Устюжанин Д.В., Добровольская С.В., Терещенко С.Н. Влияние дапаглифлозина на динамику показателей магнитно-резонансной томографии у пациентов с сердечной недостаточностью и фибрилляцией предсердий. Терапевтический архив. 2023;95(9):776–781.
DOI: 10.26442/00403660.2023.09.202368

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

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Saipudinova KM, Uskach TM, Shariya MA, Ustyuzhanin DV, Dobrovolskaya SV, Tereshchenko SN. Effect of dapagliflozin on the dynamics of magnetic resonance imaging in patients with heart failure and atrial fibrillation. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(9):776–781. DOI: 10.26442/00403660.2023.09.202368

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Аннотация

Цель. Определить влияние терапии дапаглифлозином на показатели ремоделирования и фиброза миокарда по данным магнитно-резонансной томографии (МРТ) сердца с контрастированием у пациентов с хронической сердечной недостаточностью (ХСН) и фибрилляцией предсердий (ФП).
Материалы и методы. В группе из 22 пациентов с сочетанием ХСН и ФП проанализирована динамика параметров ремоделирования и проведена оценка фиброза миокарда на фоне 6-месячной терапии дапаглифлозином по данным МРТ сердца с контрастированием.
Результаты. Через 6 мес терапии дапаглифлозином наблюдался статистически значимый прирост фракции выброса левого желудочка (27 [23–32] – 32 [26,5–36,5]; p=0,04) и тенденция к снижению объемных и линейных размеров левого желудочка, левого предсердия. В течение наблюдения не произошло прогрессирования фиброза миокарда по результатам МРТ сердца с контрастированием у пациентов с ХСН с низкой фракцией выброса и ФП.
Заключение. Применение дапаглифлозина у пациентов с ХСН с низкой фракцией выброса и ФП сопровождалось положительной динамикой обратного ремоделирования миокарда.

Ключевые слова: хроническая сердечная недостаточность, фибрилляция предсердий, ремоделирование, дапаглифлозин, магнитно-резонансная томография

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Aim. To determine the effect of dapagliflozin therapy on myocardial remodeling and fibrosis according to magnetic resonance imaging (MRI) with contrast in patients with chronic heart failure (CHF) and atrial fibrillation (AF).
Materials and methods. In the group of 22 patients with a combination of CHF and AF we analyzed the dynamics of remodeling parameters and assessed myocardial fibrosis during 6-month therapy with dapagliflozin according to cardiac MRI with contrast.
Results. After 6 months of dapagliflozin therapy there was a statistically significant increase in LVEF (27 [23–32] – 32 [26.5–36.5]; p=0.04) and a tendency to decrease volume and linear dimensions of LV, LP. There was no progression of myocardial fibrosis according to the results of cardiac MRI with contrast in patients with HFrFV and AF.
Conclusions. Dapagliflozin therapy in patients with HFrEF and AF led to favorable myocardial remodeling changes.

Keywords: chronic heart failure, atrial fibrillation, remodeling, dapagliflozin, cardiovascular magnetic resonance imaging

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Список литературы

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4. Weber C, Hung J, Hickling S, et al. Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation. Heart. 2021;107(16):1320-6. DOI:10.1136/heartjnl-2020-318648
5. Kim MH, Johnston SS, Chu BC, et al. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011;4(3):313-20. DOI:10.1161/CIRCOUTCOMES.110.958165
6. Mamas MA, Caldwell JC, Chacko S, et al. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail. 2009;11(7):676-83. DOI:10.1093/eurjhf/hfp085
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13. Kong P, Christia P, Frangogiannis NG. The pathogenesis of cardiac fibrosis. Cell Mol Life Sci. 2014;71:549-74.
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15. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020;396(10254):819‑29. DOI:10.1016/S0140-6736(20)31824-9
16. Jariwala P, Jadhav K, Punjani A, et al. ADDition of DAPAgliflozin, Sodium-Glucose Cotransporter-2 Inhibitor to Angiotensin Receptor Blocker-Neprilysin Inhibitors Non-Responders in Patient with Refractory Heart Failure with Reduced Ejection Fraction (ADD DAPA trial). Indian Heart J. 2021;73(5):605-11. DOI:10.1016/j.ihj.2021.07.005
17. Xue L, Yuan X, Zhang S, Zhao X. Investigating the Effects of Dapagliflozin on Cardiac Function, Inflammatory Response, and Cardiovascular Outcome in Patients with STEMI Complicated with T2DM after PCI. Evid Based Complement Alternat Med. 2021;2021:9388562. DOI:10.1155/2021/9388562
18. Wang H, Ding L, Tian L, et al. Empagliflozin reduces diffuse myocardial fibrosis by extracellular volume mapping: A meta-analysis of clinical studies. Front Endocrinol (Lausanne). 2022;13:917761. DOI:10.3389/fendo.2022.917761
19. Lee TM, Chang NC, Lin SZ. Dapagliflozin, a selective SGLT2 Inhibitor, attenuated cardiac fibrosis by regulating the macrophage polarization via STAT3 signaling in infarcted rat hearts. Free Radic Biol Med. 2017;104:298-310. DOI:10.1016/j.freeradbiomed.2017.01.035
20. Tian J, Zhang M, Suo M, et al. Dapagliflozin alleviates cardiac fibrosis through suppressing EndMT and fibroblast activation via AMPKα/TGF-β/Smad signalling in type 2 diabetic rats. J Cell Mol Med. 2021;25(16):7642-59. DOI:10.1111/jcmm.16601
21. Li C, Zhang J, Xue M, et al. SGLT2 inhibition with empagliflozin attenuates myocardial oxidative stress and fibrosis in diabetic mice heart. Cardiovasc Diabetol. 2019;18(1):15. DOI:10.1186/s12933-019-0816-2

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1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24(1):4-131. DOI:10.1002/ejhf.2333
2. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3(1):7-11. DOI:10.15420/cfr.2016:25:2
3. Chiang CE, Naditch-Brule L, Murin J, et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ Arrhythm Electrophysiol. 2012;5(4):632-9.
4. Weber C, Hung J, Hickling S, et al. Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation. Heart. 2021;107(16):1320-6. DOI:10.1136/heartjnl-2020-318648
5. Kim MH, Johnston SS, Chu BC, et al. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011;4(3):313-20. DOI:10.1161/CIRCOUTCOMES.110.958165
6. Mamas MA, Caldwell JC, Chacko S, et al. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail. 2009;11(7):676-83. DOI:10.1093/eurjhf/hfp085
7. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200. DOI:10.1093/eurheartj/ehw128
8. Tereshchenko SN, Galyavich AS, Uskach TM. 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083 (in Russian). DOI:10.15829/1560-4071-2020-4083
9. Maddox TM, Januzzi JL, Larry A, et al. 2021 Upd ate to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Se t Oversight Committee. J Am Coll Cardiol. 2021;77(6):772-810. DOI:10.1016/j.jacc.2020.11.022
10. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. DOI:10.1056/NEJMoa1911303
11. Kramer DG, Trikalinos TA, Kent DM, et al. Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach. J Am Coll Cardiol. 2010;56:392-406. DOI:10.1016/j.jacc.2010.05.011
12. Triposkiadis F, Pieske B, Butler J, et al. Global left atrial failure in heart failure. Eur J Heart Fail. 2016;18:1307-20. DOI:10.1002/ ejhf.645
13. Kong P, Christia P, Frangogiannis NG. The pathogenesis of cardiac fibrosis. Cell Mol Life Sci. 2014;71:549-74.
14. Flett AS, Hasleton J, Cook C, et al. Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. JACC Cardiovasc Imaging. 2011;4(2):150-6. DOI:10.1016/j.jcmg.2010.11.015
15. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020;396(10254):819‑29. DOI:10.1016/S0140-6736(20)31824-9
16. Jariwala P, Jadhav K, Punjani A, et al. ADDition of DAPAgliflozin, Sodium-Glucose Cotransporter-2 Inhibitor to Angiotensin Receptor Blocker-Neprilysin Inhibitors Non-Responders in Patient with Refractory Heart Failure with Reduced Ejection Fraction (ADD DAPA trial). Indian Heart J. 2021;73(5):605-11. DOI:10.1016/j.ihj.2021.07.005
17. Xue L, Yuan X, Zhang S, Zhao X. Investigating the Effects of Dapagliflozin on Cardiac Function, Inflammatory Response, and Cardiovascular Outcome in Patients with STEMI Complicated with T2DM after PCI. Evid Based Complement Alternat Med. 2021;2021:9388562. DOI:10.1155/2021/9388562
18. Wang H, Ding L, Tian L, et al. Empagliflozin reduces diffuse myocardial fibrosis by extracellular volume mapping: A meta-analysis of clinical studies. Front Endocrinol (Lausanne). 2022;13:917761. DOI:10.3389/fendo.2022.917761
19. Lee TM, Chang NC, Lin SZ. Dapagliflozin, a selective SGLT2 Inhibitor, attenuated cardiac fibrosis by regulating the macrophage polarization via STAT3 signaling in infarcted rat hearts. Free Radic Biol Med. 2017;104:298-310. DOI:10.1016/j.freeradbiomed.2017.01.035
20. Tian J, Zhang M, Suo M, et al. Dapagliflozin alleviates cardiac fibrosis through suppressing EndMT and fibroblast activation via AMPKα/TGF-β/Smad signalling in type 2 diabetic rats. J Cell Mol Med. 2021;25(16):7642-59. DOI:10.1111/jcmm.16601
21. Li C, Zhang J, Xue M, et al. SGLT2 inhibition with empagliflozin attenuates myocardial oxidative stress and fibrosis in diabetic mice heart. Cardiovasc Diabetol. 2019;18(1):15. DOI:10.1186/s12933-019-0816-2

Авторы

К.М. Сайпудинова*¹, Т.М. Ускач^1,2, М.А. Шария^1,3, Д.В. Устюжанин¹, С.В. Добровольская¹, С.Н. Терещенко¹

¹ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия;
²ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
³ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*saiputdinova93@mail.ru

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Karina M. Saipudinova*¹, Tatiana M. Uskach^1,2, Merab A. Shariya^1,3, Dmitry V. Ustyuzhanin¹, Svetlana V. Dobrovolskaya¹, Sergey N. Tereshchenko¹

¹Chazov National Medical Research Center of Cardiology, Moscow, Russia;
²Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
³Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*saiputdinova93@mail.ru

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