821 DAPAGLIFOZIN ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH CHRONIC HEART FAILURE AND WITHOUT DIABETIC MELLITUS.


 
 
 :Heart failure (HF) with reduced ejection fraction (HFrEF) remains a challenging problem due to its high mortality rate. Another novelty in HF therapy is dapagliflozin, a sodium–glucose transporter–2 inhibitor (SGLT2i) which decreased the rates of cardiac death and worsening of HF in the DAPA–HF trial, when added in other guideline recommended therapy.
 
 
 
 A prospective cohort study of 30 symptomatic HF patients with EF < 35% (aged 65 610 years) (20 males and 10 females) was conducted. The patients of NYHA classification II–III, previously treated with ARNI, b– blocker, and mineralocorticoid receptor antagonists (MRA) were included. Dapagliflozin 10 mg was added as a novel therapy of HF patients. Clinical examination and complete echocardiographic evaluation were performed at baseline and 30 days after the addition of SGLT2i to their treatment. 2D echocardiography and Doppler measurements were used for the evaluation of left ventricular function, and more specifically, peak early (E–wave) and late (A–wave) transmitral filling velocities and their ratio E/A, deceleration time of E velocity (DTE). To classify diastolic dysfunction according to the ASE/EACVI guidelines published in 2016, transmitral E and A waves velocities, septal and lateral E’ tissue velocities, indexed left atrium volume and peak velocity of tricuspid regurgitation were collected.
 
 
 
 After 30 days of therapy with dapagliflozin, blood pressure was reduced significantly and the echocardiographic parameters of diastolic function were improved. More specifically, after 6.163.6 months of treatment E/A ratio decreased from 1.7 61.5 to 1.0160.70 (P < 0.05), the E/Ea ratio decreased from 13.56 6.3 vs. 10.26 5.2 (P < 0.05), tricuspid regurgitation peak velocity decreased from 3.060.4 to 2.46 0.5m/s (P ¼ 0.03) and left atrial volume decreased from 53 629.3 to 40.3611.5ml/m2 (P < 0.05). Subsequently, both left–ventricular diastolic function and filling pressure improved significantly (P < 0.05,).
 
 
 
 Our data support the evidence that SGLT2i ameliorate echocardiographic indexes of diastolic function. The ratio of early diastolic transmitral flow velocity seems to correlate well with LV filling pressures, and may be use das a prognostic tool in patients with HFrEF. We have to emphasize that the diastolic function improvement may be considered an early marker.
