SGLT2 Inhibitors Improve Subclinical Left Ventricular Systolic Function Independent of Body Mass Index in Patients with Type 2 Diabetes: A Prospective Strain Imaging Study

Abstract

Background: Type 2 diabetes mellitus is associated with subclinical left ventricular dysfunction. SGLT2 inhibitors demonstrate cardiovascular benefits in trials, but their effects on subclinical myocardial function and relationship to body weight in clinical practice remain unclear. This study examined global longitudinal strain (GLS) changes during SGLT2 inhibitor therapy across body mass index (BMI) categories. Methods: This prospective observational cohort enrolled 614 patients newly initiated on SGLT2 inhibitors (September 2022-May 2025), stratified by BMI: normal weight (n = 300) and overweight/obesity (n = 314). Speckle tracking echocardiography assessed GLS at baseline and 6 months. Results: Both groups showed significant GLS improvement (normal weight: -17.83 +/- 1.30% to -19.22 +/- 1.20%; overweight/obesity: -17.70 +/- 1.48% to -19.05 +/- 1.24%; both p < 0.001), with similar magnitude (p = 0.696). Overweight/obesity patients experienced modest BMI reduction (-0.66 kg/m(2), p < 0.001); normal weight remained stable. Baseline GLS strongly predicted improvement (OR = 1.553, p < 0.001), while baseline BMI showed no association (OR = 1.000, p = 0.993). Conclusion: SGLT2 inhibitor therapy was associated with similar subclinical left ventricular systolic function improvement across BMI categories. While causality cannot be established without controls and BMI imperfectly measures adiposity, findings align with randomized trial cardiovascular benefits, suggesting benefits may extend across the body weight spectrum.