Targeting epicardial adipose tissue in heart failure with preserved ejection fraction: exploring the dapagliflozin connection

Abstract Background Heart failure with preserved ejection fraction is the fastest-growing subtype of heart failure, especially among the elderly. Aim It is aimed to determine whether the addition of 10 mg of Dapagliflozin for HFpEF patient can lead to a decrease in epicardial adipose tissue volume. Methods this non-randomized clinical trial included 60 patients presented with left ventricular diastolic dysfunction (30 patients fulfilling HFpEF diagnostic criteria received dapagliflozin 10 mg once daily in addition to standard medical therapy and 30 patients with LV diastolic dysfunction who did not meet HFpEF criteria received standard medical care only). Results The mean EAT volume was significantly (p < 0.001) higher in the HFpEF + dapagliflozin group vs. standard care group at baseline while it was comparable in the two groups at follow-up (p = 0.081). For within group comparisons, insignificant (p = 0.124) change was recorded for the standard care group while there was significant reduction in the HFpEF + dapagliflozin arm (p < 0.001). Additionally, EAT reduction in the HFpEF + dapagliflozin group was confirmed by the interaction between time and treatment modality (p < 0.001). Conclusions SGLT2 inhibitor use was associated with a significant reduction in epicardial adipose tissue, a fat depot implicated in HFpEF pathophysiology. This finding suggested a possible structural association that warrants confirmation in randomized out-come driven trials. Trial registration NO. (NCT06510270) (first submitted date 15/7/2024, first posted date 19/7/2024)