Diabetic cardiomyopathy (DCM) often begins with diastolic dysfunction, which contributes to elevated left ventricular filling pressures and progressive left atrial enlargement. A prospective observational study published in Acta Diabetologica evaluated whether dapagliflozin was associated with early cardiac structural changes in patients with type 2 diabetes mellitus (T2DM).

The single-center study enrolled 36 patients with T2DM who initiated dapagliflozin 10 mg once daily, with 35 patients completing 6-month follow-up. Transthoracic echocardiography, exercise electrocardiography testing, and laboratory assessments were performed at baseline and after 6 months of therapy. The primary focus was change in left atrial volume index (LAVI), a marker associated with diastolic dysfunction and cardiac remodeling.

Findings

• LAVI decreased significantly during dapagliflozin treatment, from 31.7 ± 10.6 to 27.9 ± 10.6 mL/m² (P < .01).
• Interventricular septum and posterior wall thicknesses also declined significantly over 6 months (P < .01).
• Significant LAVI reduction was observed among asymptomatic patients without clinical heart failure and baseline LAVI <34 mL/m², while numerical reductions in the heart failure subgroup did not reach statistical significance.
• Exercise duration, maximum metabolic equivalents (METs), and resting heart rate improved significantly during follow-up (all P < .01).
• High-density lipoprotein (HDL) cholesterol increased significantly from 46.0 ± 7.4 to 48.2 ± 8.1 mg/dL (P = .03).
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels declined significantly during treatment.

The analysis showed lower LAVI values after 6 months of dapagliflozin treatment, consistent with a possible association with early structural remodeling in diabetic cardiomyopathy. However, the uncontrolled single-arm design limits causal interpretation, and the observed cardiac, metabolic, and exercise-related findings should be considered exploratory.