Echocardiography. 2026 Apr;43(4):e70431. doi: 10.1111/echo.70431.
ABSTRACT
BACKGROUND: This study evaluated the association of empagliflozin treatment with epicardial adipose tissue (EAT) thickness and cardiac function in patients with type 2 diabetes mellitus (T2DM) without established cardiovascular disease.
METHODS: In this prospective single-arm study, 75 adults with T2DM on stable oral antidiabetic therapy received empagliflozin 10 mg once daily for 6 months. Patients with known cardiovascular disease, heart failure, or renal dysfunction were excluded. Transthoracic echocardiography was performed at baseline and follow-up to quantify EAT thickness and cardiac function parameters. Laboratory assessments included glycaemic indices, lipid profile, and inflammatory biomarkers. Changes (Δ) in EAT were correlated with changes in metabolic, inflammatory, and echocardiographic parameters.
RESULTS: The cohort (mean age 58.5 ± 8.3 years; 44% male) exhibited a significant reduction in EAT thickness (from 0.77 ± 0.07 cm to 0.69 ± 0.06 cm; p < 0.001). Significant improvements were observed in fasting glucose (182 ± 60.2 to 132 ± 16.2 mg/dL; p < 0.001), HbA1c (9.17% ± 1.24% to 8.36% ± 1.01%; p < 0.001), LDL-C (112 ± 28.9 to 106 ± 26.4 mg/dL; p < 0.001), HDL-C (46.5 ± 10.5 to 47.5 ± 9.6 mg/dL; p < 0.001), CRP (3.95 ± 2.36 to 3.32 ± 0.71 mg/L; p = 0.005), and neutrophil-to-lymphocyte ratio (1.82 ± 0.61 to 1.66 ± 0.58; p = 0.016). Diastolic indices improved, including E/e' (6.88 ± 2.03 to 6.64 ± 1.49; p = 0.011), isovolumic relaxation time (96.7 ± 10.7 to 93.6 ± 10.5 ms; p < 0.001), and deceleration time (214 ± 32.2 to 210 ± 29.6 ms; p < 0.001), whereas left ventricular ejection fraction remained stable (62.3% ± 1.47% vs. 62.5% ± 0.99%; p = 0.653). Among cardiovascular risk factors, only smoking was associated with higher baseline EAT thickness. ΔEAT did not correlate significantly with changes in HbA1c, BMI, CRP, NLR, LDL-C, HDL-C, or diastolic parameters, but showed a moderate inverse correlation with baseline EAT (r = -0.51; p < 0.001).
CONCLUSION: Empagliflozin therapy was associated with significant EAT thinning and favorable within-subject changes in selected diastolic indices and cardiometabolic markers in T2DM patients without established cardiovascular disease. The magnitude of EAT reduction was not significantly correlated with changes in conventional metabolic or inflammatory parameters; however, given the single-arm design and absence of a control group, causal and mechanistic inferences cannot be made, and these findings should be considered hypothesis-generating. Future controlled studies are warranted to confirm these observations and clarify underlying mechanisms.
PMID:41902370 | DOI:10.1111/echo.70431