https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 2Städt. Klinikum Solingen gGmbH Klinik für Kardiologie und internistische Intensivmedizin Solingen, Deutschland; 3Klinikum Chemnitz gGmbH Innere Medizin I - Kardiologie Chemnitz, Deutschland
Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated efficacy in reducing cardiovascular mortality and heart failure (HF)-related hospitalizations. However, the differential impact of SGLT2is, specifically empagliflozin and dapagliflozin, on cardiac structure and function remains unclear.
Aim: This study aims to compare the effects of empagliflozin and dapagliflozin on echocardiographic parameters in HF patients over a one-year follow-up period.
Methods: This retrospective study included 558 consecutive HF patients newly prescribed either dapagliflozin or empagliflozin. Key echocardiographic parameters, such as peak E-wave velocity, E/e' ratio, E/A ratio, deceleration time, left atrial volume index (LAVI), left ventricular (LV) volumes, LV mass index (LV-MI), relative wall thickness (RWT), LV sphericity index (LV-SI), and ejection fraction (LVEF), were measured at baseline and after one year.
Results: In this cohort, 294 patients (53%) received empagliflozin. At the one-year Follow-up, significant reductions were observed only in the empagliflozin group for peak E-wave velocity (mean difference = -12.76 cm/s, 95% CI: -16.26 to -9.27, p<0.001), E/e' ratio (mean difference = -3.04, 95% CI: -4.17 to -1.91, p<0.001), and LV sphericity index (LV-SI; mean difference = -0.01, 95% CI: -0.02 to -0.0005, p=0.040). Both SGLT2is significantly improved E-wave deceleration time, LAVI, LV end-diastolic and end-systolic volumes (LV-EDVI, LV-ESVI), LV-MI, and LVEF. Neither medication produced significant changes in RWT, and no significant differences were noted between groups regarding HF hospitalizations or all-cause mortality.
Conclusion: Empagliflozin demonstrated more pronounced effects on LV remodeling markers, including peak E-wave velocity, E/e' ratio, and LV-SI, compared to dapagliflozin. These findings suggest potential efficacy differences between SGLT2is, highlighting the need for further comparative studies.