Title:Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiac Structural
and Electrical Remodeling: From Myocardial Cytology to Cardiodiabetology
Volume: 20
Issue: 2
Author(s): Maria Marketou*, Joanna Kontaraki, Spyros Maragkoudakis, Christos Danelatos, Sofia Papadaki, Stelios Zervakis, Anthoula Plevritaki, Panos Vardas,, Fragiskos Parthenakis and George Kochiadakis
Affiliation:
- Cardiology Department, Heraklion University Hospital, Crete, Greece
Keywords:
Sodium–glucose cotransporter-2 inhibitors, diabetes, remodelling, myocardial cytology, cardiodiabetology.
Abstract: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have changed the clinical landscape
of diabetes mellitus (DM) therapy through their favourable effects on cardiovascular outcomes.
Notably, the use of SGLT2i has been linked to cardiovascular benefits regardless of DM status,
while their pleiotropic actions remain to be fully elucidated. What we do know is that SGLT2i
exert beneficial effects even at the level of the myocardial cell and that these are linked to an improvement
in the energy substrate, resulting in less inflammation and fibrosis. SGLT2i ameliorates
myocardial extracellular matrix remodeling, cardiomyocyte stiffness and concentric hypertrophy,
achieving beneficial remodeling of the left ventricle with significant implications for the pathogenesis
and outcome of heart failure. Most studies show a significant improvement in markers of diastolic
dysfunction along with a reduction in left ventricular hypertrophy. In addition to these effects,
there is electrophysiological remodeling, which explains initial data suggesting that SGLT2i have
an antiarrhythmic action against both atrial and ventricular arrhythmias. However, future studies
need to clarify not only the exact mechanisms of this beneficial functional, structural, and electrophysiological
cardiac remodeling but also its magnitude to determine whether this is a class or a
drug effect.
