Dapagliflozin reduces epicardial adipose tissue in patients with heart failure and type 2 diabetes.
BACKGROUND: Epicardial adipose tissue (EAT) has a contributory role in the progression of heart failure. We tested whether dapagliflozin reduces EAT in adults with type 2 diabetes (T2D) and heart failure and explored links with systemic inflammation and cardiac structure. METHODS: This analysis is based on pooled data from two phase 2, single-centre, double-blind, placebo-controlled randomised trials (REFORM and DAPA-LVH) conducted in Scotland. Exactly 122 participants with T2D and stage B or C heart failure were randomised to dapagliflozin 10 mg once daily or placebo for 12 months. Cardiac magnetic resonance imaging (CMR) was used to assess EAT. At baseline and follow-up, the inflammatory markers TNF, IL-1, IL-6, IL-10, and CRP were measured. RESULTS: At baseline, obesity was common (75% with BMI ≥30 kg/m2) and heart-failure phenotypes were balanced (HFpEF 51%, HFrEF 49%). After 12 months, dapagliflozin significantly reduced EAT independently of changes in BMI (-1.16 ± 0.18 vs. +0.36 ± 0.19 cm2, p < 0.001), BMI (-1.17 ± 0.16 vs. -0.18 ± 0.17 kg/m2, p < 0.001), and left ventricular mass (-3.53 ± 1.77 vs. +1.57 ± 1.83 g, p = 0.048) compared with placebo. CONCLUSION: Dapagliflozin shrinks EAT and LV mass independently of BMI in T2D patients with stage B/C heart failure, supporting EAT as a modifiable target of SGLT2 inhibition. The absence of parallel changes in systemic inflammation suggests primarily local mechanisms.