Sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of major adverse cardiovascular (CV) events and hospitalization for heart failure (HF) in patients with type 2 diabetes (T2D). Using CV MRI (CMR) and ³¹P-MRS in a longitudinal cohort study, we aimed to investigate the effects of the selective SGLT2 inhibitor empagliflozin on myocardial energetics and cellular volume, function, and perfusion. Eighteen patients with T2D underwent CMR and ³¹P-MRS scans before and after 12 weeks’ empagliflozin treatment. Plasma N-terminal prohormone B-type natriuretic peptide (NT-proBNP) levels were measured. Ten volunteers with normal glycemic control underwent an identical scan protocol at a single visit. Empagliflozin treatment was associated with significant improvements in phosphocreatine-to-ATP ratio (1.52 to 1.76, P = 0.009). This was accompanied by a 7% absolute increase in the mean left ventricular ejection fraction (P = 0.001), 3% absolute increase in the mean global longitudinal strain (P = 0.01), 8 mL/m² absolute reduction in the mean myocardial cell volume (P = 0.04), and 61% relative reduction in the mean NT-proBNP (P = 0.05) from baseline measurements. No significant change in myocardial blood flow or diastolic strain was detected. Empagliflozin thus ameliorates the "cardiac energy-deficient" state, regresses adverse myocardial cellular remodeling, and improves cardiac function, offering therapeutic opportunities to prevent or modulate HF in T2D.

钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂可降低 2 型糖尿病 (T2D) 患者发生主要不良心血管 (CV) 事件和因心力衰竭 (HF) 住院的风险。我们在纵向队列研究中使用 CV MRI (CMR) 和^{31 P-MRS，旨在研究选择性 SGLT2 抑制剂恩格列净对心肌能量和细胞体积、功能和灌注的影响。}18 名 T2D 患者在恩格列净治疗 12 周之前和之后接受了 CMR 和^{31 次P-MRS 扫描。}测量血浆 N 端激素原 B 型利钠肽 (NT-proBNP) 水平。十名血糖控制正常的志愿者在一次就诊中接受了相同的扫描方案。恩格列净治疗与磷酸肌酸与 ATP 比率的显着改善相关（1.52 至 1.76，P = 0.009）。伴随着平均左心室射血分数绝对增加 7% ( P = 0.001)、平均总体纵向应变绝对增加 3% ( P = 0.01)、平均心肌细胞绝对减少8 mL/m ²体积（P = 0.04），平均 NT-proBNP 相对于基线测量值相对减少 61%（ P = 0.05）。未检测到心肌血流量或舒张压应变的显着变化。因此，恩格列净可改善“心脏能量缺乏”状态，逆转不利的心肌细胞重塑，并改善心脏功能，为预防或调节 T2D 心力衰竭提供治疗机会。