systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2022-1-39-48systhiper-6Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEСравнительная оценка влияния агониста рецепторов глюкагоноподобного пептида 1 типа семаглутида и ингибитора натрий зависимого ко-траспортера глюкозы эмпаглифлозина на диастолическую функцию левого желудочка у пациентов с артериальной гипертонией, ожирением и сахарным диабетом 2 типаComparative evaluation new glucagon-like peptide 1 receptor agonist semaglutide and sodium-glucose cotransporter-2 inhibitors empagliflozin on left ventricular diastolic function in patients with arterial hypertension, obesity and type 2 diabetes mellitushttps://orcid.org/0000-0001-7092-8689АзимоваМ. Р.AzimovaM. R.

Азимова Марина Ризвановна, аспирант отд. гипертонии

ул. 3-я Черепковская, д. 15а, г. Москва 121552

Marina R. Azimova, Postgraduate Student, Department of Hypertension, A.L. Myasnikov Research Institute of Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

azimovamak@gmail.comhttps://orcid.org/0000-0001-7895-9068ЖернаковаЮ. В.ZhernakovaYu. V.

Жернакова Юлия Валерьевна, ученый секретарь

ул. 3-я Черепковская, д. 15а, г. Москва 121552

тел.: +7(495) 414-63-00

Yuliya V. Zhernakova, Prof., Dr. of Sci. (Med.), Scientific Secretary of the Institute of Clinical Cardiology named after A.L. Myasnikov, National Medical Research Center of Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

+7(495) 495-414-63-00

juli001@mail.ruhttps://orcid.org/0000-0002-3233-1862СаидоваМ. А.SaidovaM. A.

Саидова Марина Абдулатиповна, д-р мед. наук, проф., рук. отдела ультразвуковых методов диагностики

ул. 3-я Черепковская, д. 15а, г. Москва 121552

Marina A. Saidova, Prof., Dr. of Sci. (Med.), Head of the Department of Ultrasound Diagnostic Methods, A.L. Myasnikov Research Institute of Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

https://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.

Чазова Ирина Евгеньевна, д-р мед. наук, проф., акад. РАН, рук. отдела гипертонии

ул. 3-я Черепковская, д. 15а, г. Москва 121552

тел.: +7(495)415-52-05

Irina E. Chazova (chairman), Prof., Dr. of Sci. (Med.), Academician of RAS, Deputy General Director for Scientific and Expert Work, Head of Hypertension Department, A.L. Myasnikov Research Institute of Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

Phone: +7(495) 415-52-05

c34h@yandex.ruИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова» Минздрава РоссииРоссияE.I. Chazov National Medical Research Center of CardiologyRussian Federation2022161020221913948Copyright © Азимова М.Р., Жернакова Ю.В., Саидова М.А., Чазова И.Е., 20222022Азимова М.Р., Жернакова Ю.В., Саидова М.А., Чазова И.Е.Azimova M.R., Zhernakova Y.V., Saidova M.A., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/6Цель исследования

Цель исследования: провести сравнительный анализ влияния 24 недельной терапии агонистом рецепторов глюкагоноподобного пептида-1 (аГПП-1) семаглутидом и ингибитором натрий зависимого переносчика глюкозы 2-го типа (иНГЛТ) эмпаглифлозином на структурно-функциональные состояния левых отделов сердца и выраженность эпикардиальной жировой ткани (ЭЖТ) у пациентов с АГ, ожирением и СД 2 типа.

Материалы и методы

Материалы и методы: в исследование последовательно был включен 91 пациент (40,7% женщин и 59,3% мужчин) в возрасте от 44–65 лет с СД 2 типа (уровень гликированного гемоглобина > 6,5%) и ожирением (окружность талии более 80 см у женщин и более 94 см у мужчин). Все пациенты получали стандартную антигипертензивную и гиполипидемическую терапию, кроме того, все пациенты находились на монотерапии метформином в дозе 1000-2000 мг/сут (за время наблюдения терапия не менялась). Всем пациентам проводились антропометрические измерения, для оценки структурно-функциональных параметров ЛЖ проводилась ЭхоКГ методом трансмитральной и тканевой миокардиальной допплерографии с определением толщины ЭЖТ. После предварительного обследования все пациенты были рандомизированы на две группы: 1-ой группе была назначена терапия семаглутидом с начальной дозой 0,25 мг и постепенной титрацией каждые 4 недели до 1,0 мг, 2-ой группе был назначен эмпаглифлозин в дозе 10 или 25 мг. Через 24 недели всем пациентам повторно проведено обследование.

Результаты

Результаты: лечение семаглутидом и эмпаглифлозином улучшало структурно-функциональное состояние левых отделов сердца — снижало массу миокарда ЛЖ, индекс массы миокарда ЛЖ, индекс объема ЛП, улучшало большинство показателей диастолической функции ЛЖ (соотношение Е/А, диастолического наполнения ЛЖ, скоростных показателей движения фиброзного кольца от латеральной и митральной стенок ЛЖ) у пациентов с АГ, ожирением и СД 2 типа. Кроме того, в группе семаглутида выявлено выраженное уменьшение толщины ЭЖТ в систолу с 0,76 см [0,56; 0,8] до 0,71 см [0,5; 0,74] (р<0,001), чего не наблюдалось в группе эмпаглифлозина. По-видимому, положительное влияние семаглутида и эмпаглифлозина на состояние левых отделов сердца достигается разными механизмами. В 1-й группе за счет уменьшения ИММЛЖ, толщины ЭЖТ, во 2-й за счет снижения преднагрузки на ЛЖ и уменьшения давления наполнения ЛЖ, что приводит к улучшению процессов релаксации.

Заключение

Заключение: у лиц с СД 2 типа и ССЗ или высоким риском их развития необходимо назначение современных классов сахароснижающих препаратов с учетом их влияния на сердечно-сосудистый прогноз, а в некоторых случаях рассмотрения необходимости комбинации этих препаратов.

The aim of this study is conducting a comparative analysis of the effect of 24 weeks of therapy of glucagon-like peptide-1 receptor agonists (aGLP-1) semaglutide and a sodium-glucose co-transporter 2 inhibitors (SGLT2) empaglifosin on the left heart chambers and the severity of epicardial adipose tissue (EAT) in patient with arterial hypertension (АН), obesity and diabetes mellitus (DM).

Materials and methods

Materials and methods: 91 patients (40.7% women and 59.3% men) aged 44-65 years with type 2 DM (glycated hemoglobin level over 6.5%) and obesity (WC over 80 cm in women and over 94 cm in men) were successively included in the study. All patients received standard antihypertensive and hypolipidemic therapy, in addition, all patients were on metformin monotherapy at a dose of 1000-2000 mg/day (during the follow-up, the therapy did not change). Anthropometric measurements, echocardiography were carried out to evaluate the structural and functional parameters of LV using transmitral and tissue Doppler and determine the thickness of EAT. After a preliminary examination, all patients were randomized on two groups: the 1st group was prescribed semaglutide therapy with an initial dose of 0.25 mg and gradual titration every 4 weeks to 1.0 mg, the 2nd group was prescribed empagliflozin at a dose of 10 or 25 mg. After 24 weeks, all patients were re-examined.

Results

Results: semaglutide and empagliflozin improved a structural and functional condition of the left heart chambers — LV mass, LV mass index (LVMI), the LA index volume, practically all of indicators of the LV diastolic function (E/A ratio, LV-filling pressure, Еmlat , Emsept velosity) in patients with AH, obesity and DM 2 types. In addition, in the semaglutide group, a pronounced decrease in the EAT thickness with 0.76 cm [0.56; 0.8] to 0.71 cm [0.5; 0.74] (p < 0.001), which was not observed in the empagliflozin group. Apparently, semaglutide and empagliflozin positive effect on the left heart chambers achieved by the different mechanisms. In the 1st group by means of decrease LVMI and EAT thickness, in the 2nd group through reduction heart preload and LV-filling pressure according improve LV relaxation.

Conclusion

Conclusion: the new sugar-lowering agents should be prescribed to patients with type 2 DM and CVD or a high risk of CVD development taking into account their impact on the cardiovascular prognosis, and in some cases considering the need for a combination of these drugs.

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The authors declare that there are no conflicts of interest present.