Recently, large clinical intervention studies have demonstrated the cardiovascular protective
effects on of sodium-glucose cotransporter 2 inhibitors (SGLT2i) such as empagliflozin,
dapagliflozin, and canagliflozin in reduction of cardiovascular and all-cause mortality,
coincident with a significant reduction in heart failure hospitalizations. Therefore, SGLT2i
had been recommended as a therapeutic drug for diabetic patients to reduce the occurrence of
cardiovascular events. However, the mechanism of these benefits remains unclear at the
present time.
Myocardial fibrosis is not only an important physiopathological mechanism of heart failure,
but also has been shown to be closely associated with the risk of heart failure-related
hospitalization and death, especially in patients with T2D. However, whether SGLT2i can exert
cardioprotective effects by improving myocardial fibrosis remains to be further investigated.
In recent years, the development of cardiac magnetic resonance (CMR) technology enables to
detect focal and diffuse fibrosis in myocardial tissue, which makes it possible to
systematically explore the role of SGLT2i on myocardial fibrosis. Although several studies
including EMPA-HEART, SUGAR-DM-HF have explored the effects of SGLT2i on cardiac structure
and function, these studies didn't reach consistent results. In addition, more scarce studies
have investigated the effects of SGLT2i on both focal and diffuse fibrosis. At present,
whether SGLT2i treatment can change the relevant indicators of myocardial fibrosis in people
with diabetes and cardiovascular risk factors has not yet been reported. In addition,
previous studies mainly focus on empagliflozin and dapagliflozin, and studies on
canagliflozin are still very scarce. Therefore, this study intends to explore the effects of
canagliflozin on myocardial fibrosis and other structures and functions of the heart in
patients with type 2 diabetes mellitus and high cardiovascular risk factors.