Effect of Empagliflozin on Left Ventricular Mechanics: Review Article

Background: Cardiovascular morbidity and mortality are still significantly influenced by heart failure and subclinical left ventricular (LV) dysfunction, especially in individuals with type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter type 2 (SGLT2) inhibitors have shown substantial cardiovascular advantages in addition to glycemic management. Objective: To evaluate effect of empagliflozin on left ventricular mechanics. Methods: We used PubMed, Google Scholar and Scopus with keywords including Empagliflozin, SGLT2 inhibitors, Left ventricular mechanics, Global longitudinal strain, Speckle-tracking echocardiography, Heart failure, Diastolic dysfunction and Type 2 diabetes mellitus. The writers evaluated relevant literature references as well. Only the most recent or thorough investigations, from 2012 to 2022, were taken into account. Documents written in languages other than English were ignored. Papers that were not regarded as significant scientific research included dissertations, oral presentations, conference abstracts, and unpublished manuscripts were excluded. Conclusion: In both diabetic and non-diabetic populations, empagliflozin, a selective SGLT2 inhibitor, has been demonstrated to lower hospitalization for heart failure and cardiovascular death. Recent data indicate that these advantages might be mediated, at least partially, by positive effects on left ventricular mechanics, such as enhancements in myocardial deformation metrics like diastolic function, LV stiffness, and global longitudinal strain (GLS). Independent of its glucose-lowering action, empagliflozin may improve LV systolic and diastolic function by lowering preload and afterload, enhancing myocardial energetics, reducing interstitial fibrosis, and altering inflammatory and neurohormonal pathways. These subclinical changes in LV mechanics can be detected with sensitive tools using advanced echocardiographic techniques, including speckle-tracking echocardiography, before overt changes in ejection fraction become apparent.