Abstract 12880: Left Ventricular Mass Predicts Cardiac Reverse Remodeling in Patients With Type 2 Diabetes and Coronary Artery Disease Who Are Treated With Empagliflozin

Introduction: Left ventricular (LV) hypertrophy is associated with an elevated risk for cardiovascular disease and all-cause mortality. The cardiovascular benefits of sodium-glucose cotransporter protein-2 (SGLT2) inhibitors have been attributed, in part, to cardiac reverse remodeling. The EMPA-HEART CardioLink-6 study previously reported that SGLT2 inhibition with empagliflozin for 6 months was associated with a significant reduction in LV mass indexed to body surface area (LVMi). We sought to determine in the same cohort if baseline LVMi influences empagliflozin-associated cardiac reverse remodelling. Methods: A total of 97 patients with type 2 diabetes and coronary artery disease was randomized to empagliflozin (10 mg/d) or matching placebo for 6 months in the EMPA-HEART CardioLink-6 study. This cohort was stratified into those with baseline LVMi <60 g/m 2 and those with LVMI ≥60 g/m 2 . Between-group comparisons were conducted using a linear regression model adjusted for baseline differences in LVMi (ANCOVA) that included an interaction term between baseline LVMi sub-group and treatment. Results: The effect empagliflozin had on the change in LVMi over 6 months was significantly different between patients with a baseline LVMi <60 g/m 2 and those whose LVMi was ≥60 g/m 2 . The adjusted difference between those randomized to empagliflozin and those assigned placebo after multivariable adjustment for baseline characteristics was 0.59 g/m 2 (95% CI: -3.01 g/m 2 , 4.19 g/m 2 , P=0.74) and -7.03 g/m 2 (95% CI: -11.06 g/m 2 , -2.99 g/m 2 , P=0.001) in the LVMi <60 g/m 2 and LVMi ≥60 g/m 2 subgroups, respectively (P interaction =0.0054). No significant association was found between baseline LVMi and 6-month change in LV end systolic volume-indexed (P interaction =0.086), LV end diastolic volume-indexed (P interaction =0.34), or LV ejection fraction (P interaction =0.15). Conclusions: In the EMPA-HEART CardioLink-6 cohort, greater cardiac reverse remodelling benefits were observed with empagliflozin in patients with higher baseline LVMi. Studies with larger cohorts and longer follow-ups are warranted to confirm the impact baseline LV mass has on SGLT2 inhibitor-associated remodelling.