Sodium–Glucose Cotransporter 2 Inhibitors Shorten Echocardiography-Derived Total Atrial Conduction Time in Patients With Type 2 Diabetes Mellitus: A Prospective Pilot Study

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). Structural and electrical atrial remodeling are among the myocardial alterations associated with diabetes. Total atrial conduction time (TACT), derived from echocardiography, serves as a marker of atrial remodeling. However, the effect of SGLT2i on TACT remains unclear. Methods: In this prospective, single-center pilot study, 130 patients with T2DM and preserved left ventricular ejection fraction were enrolled between March and December 2022. After excluding patients who discontinued therapy or met other exclusion criteria, 107 patients (57 treated with dapagliflozin and 50 with empagliflozin) were included in the analysis. Echocardiographic and laboratory evaluations were performed at baseline and six months after initiation of SGLT2i therapy. TACT was defined as the mean time between the onset of the P wave in lead II and the peak A′ wave on tissue Doppler imaging (PA-TDI). Paired statistical tests, correlation analyses, and multiple linear regression were used to identify independent predictors of Δ TACT. Results: After six months of SGLT2i therapy, significant reductions were observed in blood pressure, lipid levels, glycated hemoglobin (HbA1c), and body mass index values (all p < 0.05). Moreover, echocardiography demonstrated significant decreases in the E/e′ ratios and mean PA-TDI duration (p < 0.001). The Δ lateral E/e′ ratio and Δ body mass index (BMI) values were independently associated with Δ TACT (p = 0.001 and p = 0.026, respectively). The mean duration of SGLT2i use was 183 days. Conclusions: SGLT2i therapy was associated with a significant reduction in TACT among T2DM patients, suggesting potential improvements in atrial remodeling and diastolic function. These findings support the hypothesis that the cardiovascular benefits of SGLT2i may extend to atrial conduction properties. Nonetheless, larger randomized studies are warranted to confirm these observations.