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Sandhu P, Ong JP, Garg V, Altaha M, Bello O, Singal SR, Verma S, Yan AT, Connelly KA. The effects of saxagliptin on cardiac structure and function using cardiac MRI (SCARF). Acta Diabetol 2021; 58:633-641. [PMID: 33483855 DOI: 10.1007/s00592-020-01661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE A recent large cardiovascular outcome trial in patients with type 2 diabetes (T2DM) demonstrated excess heart failure hospitalization with saxagliptin. We sought to evaluate the impact of saxagliptin on cardiac structure and function using cardiac magnetic resonance imaging (CMR) in patients with T2DM without pre-existing heart failure. METHODS In this prospective study, patients with T2DM without heart failure were prescribed saxagliptin as part of routine guideline-directed management. Clinical assessment, CMR imaging and biomarkers were assessed in a blinded fashion and compared following 6 months of continued treatment. The primary outcome was the change in left ventricular (LV) ejection fraction (LVEF) after 6 months of therapy. Key secondary outcomes included changes in LV and right ventricular (RV) end-diastolic volume, ventricular mass, LV global strain and cardiac biomarkers [N terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP)] over 6 months. RESULTS The cohort (n = 16) had a mean age of 59.9 years with 69% being male. The mean hemoglobin A1c (HbA1c) was 8.3%. Mean baseline LVEF was 57% ± 3.4, with no significant change over 6 months (- 0.2%, 95% CI - 2.5, 2.1, p = 0.86). Detailed CMR analyses that included LV/RV volumes, LV mass, and feature tracking-derived strain showed no significant change (all p > 0.50). NT-proBNP and hsCRP levels did not significantly change (p > 0.20). CONCLUSIONS In this cohort of stable ambulatory patients with T2DM without heart failure, saxagliptin treatment was not associated with adverse ventricular remodeling over 6 months as assessed using CMR and biomarkers.
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Affiliation(s)
- Paul Sandhu
- Division of Cardiology, Queen's University, Kingston, ON, Canada
| | - Jann P Ong
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Vinay Garg
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Mustafa Altaha
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Olubenga Bello
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Sewa R Singal
- Department of Medicine, Humber River Hospital, Toronto, ON, Canada
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge St, Toronto, ON, M5B1M8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, ON, Canada.
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge St, Toronto, ON, M5B1M8, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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