Effects of sodium glucose co-transporter-2 inhibitors on aortic stiffness, diastolic function and flow-mediated dilatation in patients with diabetes mellitus

Introduction and Objectives: Atherosclerotic heart disease is the most common cause of mortality and morbidity. Endothelial dysfunction is associated with atherosclerosis and cardiovascular risk factors. Diabetes mellitus plays an important role in the development of atherosclerosis by causing endothelial dysfunction. Sodium glucose co-transporter 2 inhibitors used in T2DM treatment reduce cardiovascular death, hospitalization for hearth failure and mortality rates due to heart failure. The aim of our study is to reveal the change in diastolic parameters, flow-mediated dilatation and aortic stiffness reflecting endothelial functions in T2DM patients in whom SGLT-2 inhibitor was added to their current treatment Materials and Methods: A total of 74 patients, 17 (23%) female, 57 (77%) male, were included in the study. The mean age of the patients was 57.85 ± 9.81. Patients with a previous diagnosis of T2DM, sinus rhythm, non-hypotensive, glomerular filtration rate >60 ml/min/1.73 m2 were included in the study. The diastolic parameters, flow mediated dilatation and aortic stiffness values before and 3 months after treatment were compared in patients who were started with SGLT-2 inhibitors. Results: In the echocardiographic measurements performed in patients who were started with SGLT-2 inhibitor, a statistically significant decrease was found in septum thickness (p <0.001) and left ventricular posterior wall thickness (p = 0.015) at the end of the 3rd month. Significant increase was found in septal e '(p = 0.002) and lateral e' velocities (p = 0.003). A statistically significant improvement was observed in diastolic dysfunction degrees (p = 0.007). While there was a statistically significant change in the aortic β stiffness index (p = 0.015) at 3 months after treatment, there was no significant change in flow mediated dilatation (p = 0.198). Office systolic blood pressure (p = 0.027) was significantly decreased after treatment, whereas there was no statistically significant change in the office diastolic blood pressure (p = 0.229). Conclusion: We observed that SGLT-2 inhibitors provided significant improvement in left ventricular diastolic functions and aortic stiffness parameters. However, no statistically significant change was observed in flow mediated dilatation. Larger and long-term studies are needed to investigate the relationship between SGLT-2 inhibitors and endothelial functions. KEYWORDS: SGLT-2 inhibitor, Diastolic dysfunction, Diabetes mellitus, Hypertension