Patients with heart failure with preserved ejection fraction (HFpEF) frequently continue to experience functional limitation despite guideline-directed therapy, and the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on coronary microvascular function remain uncertain. A prospective single-center study presented at Heart Failure 2026 evaluated the effects of dapagliflozin on coronary microcirculation using cardiac magnetic resonance imaging (CMR) in patients with HFpEF.
All participants received dapagliflozin 10 mg daily in addition to guideline-directed medical therapy for 6 months. Coronary microcirculation was assessed using quantitative myocardial perfusion analysis with segmental evaluation based on the American Heart Association 6-segment model. Secondary assessments included echocardiographic parameters, B-type natriuretic peptide (BNP), urinary albumin-to-creatinine ratio (UACR), 6-minute walk test (6MWT) distance, Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, and body mass index (BMI).
Findings
- Twenty-nine patients completed 6 months of follow-up.
- CMR analysis showed no significant changes in myocardial perfusion parameters across evaluated myocardial segments (all P>0.05).
- Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVED) remained stable during follow-up (P=0.21 and P=0.89, respectively).
- BNP concentrations decreased significantly after dapagliflozin therapy (267.25 ± 194.49 pg/mL vs 215.19 ± 175.93 pg/mL; P=0.036). UACR also declined significantly [15.64 (3.44, 34.49) vs 6.28 (2.64, 17.79) mg/g; P=0.023].
- Functional capacity improved, with increased 6MWT distance (361.79 ± 100.25 m vs 386.33 ± 96.58 m; P=0.03). MLHFQ scores also improved after treatment [20.48 (8.25, 35) vs 16.73 (14.25, 16.93); P=0.048].
Six months of dapagliflozin therapy was associated with improvement in functional status, symptom measures, and selected biomarker parameters in patients with HFpEF. However, myocardial perfusion and echocardiographic structural measures remained unchanged during follow-up. Additional studies are needed to better define phenotype-specific responses to SGLT2i therapy in HFpEF.
