Effect of Dapagliflozin Combined with Metformin on Ventricular Structure and NT-proBNP Levels in Elderly Patients with Type 2 Diabetes and Ejection Fraction-preserved Heart Failure

ALEX·Abura; FAN Xiaoping; LI Jing

doi:10.12102/j.issn.1672-1349.2025.12.020

Abstract：Objective: To investigate the effects of dapagliflozin combined with metformin on ventricular structure and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in elderly patients with type 2 diabetes mellitus (T2DM) and heart failure with preserved ejection fraction (HFpEF). Methods: A total of 116 elderly T2DM patients with HFpEF admitted to our hospital from January 2021 to January 2022 were selected and divided into a control group and a study group, each with 58 cases. The control group was treated with metformin, while the study group received dapagliflozin in addition to metformin. The levels of blood glucose, pancreatic beta-cell function indicators, ventricular structure parameters, vascular endothelial function indicators, NT-proBNP, inflammatory factors, and the incidence of major adverse cardiovascular events (MACE) were compared between the two groups. Results: After treatment, fasting plasma glucose (FPG), postprandial 2-hour glucose (2 hPG), hemoglobin A1c (HbA1c), and homeostasis model assessment-insulin resistance (HOMA-IR) were lower than before treatment, while the homeostasis model assessment-beta cell function (HOMA-β) was higher than before treatment. Compared with the control group, FPG, 2 hPG, HbA1c, and HOMA-IR were reduced, and HOMA-β was increased in the study group (P < 0.05). After treatment, ventricular structure parameters including left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular mass index (LVMI), left ventricular remodeling index (LVRI), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD) were lower than before treatment, while the early diastolic mitral flow velocity/systolic mitral flow velocity ratio (E/A) was higher than before treatment. Compared with the control group, LVEDVI, LVESVI, LVMI, LVRI, LVEDD, and LVESD were reduced, and E/A was increased in the study group (P < 0.05). After treatment, endothelin-1 (ET-1) was lower than before treatment, while flow-mediated dilation (FMD) and nitric oxide (NO) levels were higher than before treatment. Compared with the control group, ET-1 was reduced, and FMD and NO were increased in the study group (P < 0.05). After treatment, NT-proBNP levels were lower than before treatment. Compared with the control group, NT-proBNP was reduced in the study group (P < 0.05). After treatment, inflammatory factors including high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-4, and IL-6 were lower than before treatment. Compared with the control group, hs-CRP, IL-4, and IL-6 were reduced in the study group (P < 0.05). Compared with the control group, the incidence of MACE was reduced in the study group (P < 0.05). Conclusion: Dapagliflozin combined with metformin can reduce blood glucose levels, inhibit insulin resistance and local inflammation, reduce NT-proBNP secretion, repair vascular endothelial injury, thereby improving ventricular structure and reducing the incidence of MACE in elderly patients with T2DM and HFpEF.