Does Treatment of Left Ventricular Diastolic Dysfunction in Chronic Obstructive Pulmonary Disease Matter: An Appraisal from an Open Prospective Real-world Observation with Use of Dapagliflozin

Background: Left ventricular diastolic dysfunction (LVDD), a common co-event of chronic obstructive pulmonary disease (COPD), can adversely influence functionality, quality of life (QoL), and survival prospects.Objective: To see the impact of treatment of LVDD with the sodium-glucose cotransporter 2 (SGLT-2) inhibitor dapagliflozin in a prospective trial.Materials and methods: Serial consenting patients with stable COPD underwent Doppler echocardiography on clinical or radiological suspicion of LVDD or pulmonary hypertension (PH).The subjects with LVDD were treated with add-on dapagliflozin in an open, prospective, real-world observation.The follow-up (FU) records of the first 35 patients were included for statistical analysis.The treatment effects were measured in terms of changes in postexercise recovery response [two-chair test (2CT)] and health status [COPD assessment test (CAT) score].Results: We included 35 patients of COPD [mean age: 67.66 ± 9.28 years, mean body mass index (BMI): 24.64 ± 3.97] with male predominance: 30:5.Their mean post-bronchodilator (BD) absolute forced expiratory volume in the first 1 second (FEV1)/forced vital capacity (FVC) and mean post-BD percentage predicted FEV1 were 0.50 ± 0.11 and 44.37 ± 15.72, respectively, with hypertension being the commonest comorbidity (30%) followed by diabetes and ischemic heart disease.On echocardiography, they displayed the mean value of pulmonary artery pressure (PAP) (systolic) as 45.43 ± 6.57, E/e' as 13.60 ± 2.52, left atrial volume index as 27.88 ± 8.54 mL/m 2 of body surface area, and tricuspid regurgitation (TR)-jet velocity as 3.04 ± 0.24.On a mean FU of 104.7 ± 70.96 days, they showed statistically significant improvement in postexercise minimum SpO 2 (p = 0.043) and desatmax (p = 0.020) of the 2CT; the CAT score also improved significantly (14.35 ± 3.00-8.93± 4.09; p < 0.0001).Repeat echocardiography, possible in nine patients, showed an improving trend in all parameters.All the patients tolerated dapagliflozin well.Conclusion: Dapagliflozin, an SGLT-2 inhibitor, improves health status and the postexercise recovery response significantly with LVDD in COPD.