Effect of pre-reperfusion SGLT2 Inhibitors on infarct size and ventricular function in patients with acute myocardial infarction

Abstract Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown cardioprotective benefits in both diabetic and non-diabetic patients. Preclinical studies suggest that early SGLT2i administration may limit myocardial ischemia/reperfusion injury. However, its effect on infarct size and ventricular remodeling during the acute phase of myocardial infarction in humans is not well established. Cardiac magnetic resonance imaging (CMR) offers a reliable method to quantify infarct size, ventricular function, and microvascular obstruction (MVO). Objective To assess the impact of pre-reperfusion dapagliflozin on infarct size and left ventricular remodeling using CMR in patients with anterior ST-elevation myocardial infarction (STEMI). Methods This is a randomized, double-blind, placebo-controlled study. Patients with anterior wall STEMI were randomized 1:1 to receive dapagliflozin (20 mg loading, then 10 mg daily) or placebo before coronary reperfusion. CMR was performed at early days and 3 months post-PCI to evaluate left ventricular volumes, ejection fraction (LVEF), infarct size (%LV mass), and MVO. Imaging was interpreted blinded to treatment allocation. Results Twenty patients with anterior wall STEMI were enrolled: 11 (55%) received dapagliflozin, while 9 (45%) received a placebo. The mean age was 67.2 ± 7.0 years, and 70% were male. Baseline infarct size was not significantly different between the two groups (36.1% vs. 31.2%, p = 0.176). MVO was present in 73% of patients receiving dapagliflozin compared to 75% of those receiving placebo (p = 0.912). At the 3-month follow-up, dapagliflozin did not result in significant reverse remodeling compared to the placebo. Median change in left ventricular end-diastolic volume index was -2.3 mL/m2 (IQR: -3.3 to 16.9) in the dapagliflozin group vs. -1.6 mL/m2 (IQR: -14.4 to 4.2) in the placebo group (p = 0.261). Median change in left ventricular end-diastolic volume index was -1.3 mL/m2 (IQR -3.3 to 3.7) vs. -2.3 mL/m2 (IQR -15.4 to 0.6), respectively (p = 0.331). Conclusion Early dapagliflozin administration before reperfusion was feasible, however, it did not significantly reduce infarct size or MVO. Further studies with larger sample sizes, longer dapagliflozin duration and follow-up are warranted to clarify its role in myocardial protection during acute myocardial infarction.Table 1.Baseline demographic and clinic Table 2.Cardiac magnetic resonance Char