Effects of dapagliflozin on ventricular remodeling and prognosis in older females with heart failure with preserved ejection fraction: A single-center prospective study

OBJECTIVE: This study aimed to evaluate the therapeutic efficacy and prognostic outcomes of dapagliflozin in older female patients with heart failure with preserved ejection fraction (HFpEF). METHODS: In a single-center, prospective study conducted from March 2022 to September 2023, a total of 299 older female patients with HFpEF were enrolled and randomly allocated to either a control group (n = 149) receiving standard heart failure therapy or an intervention group (n = 150) receiving standard therapy in combination with dapagliflozin. Baseline clinical characteristics and laboratory parameters were recorded. Key biomarkers and functional indicators were evaluated pre- and post-treatment, with comparisons within and between groups. Follow-up was conducted via outpatient visits or telephone interviews over an average period of 12 months to evaluate the incidence of heart failure-related rehospitalization, ventricular arrhythmias, and major adverse cardiovascular events (MACE). RESULTS: Following treatment, the dapagliflozin group significantly lower levels of N-terminal pro-brain natriuretic peptide, soluble suppression of tumorigenicity-2, Galectin-3, and lower (better) Minnesota Living with Heart Failure Questionnaire scores compared to the control group (all p < 0.05). At 12-month follow-up, the dapagliflozin group exhibited significant increases in left ventricular ejection fraction, estimated glomerular filtration rate, and direct bilirubin relative to baseline values (all p < 0.05). Additionally, significant reductions in C-reactive protein levels and increases in serum sodium levels were observed post-treatment (both p < 0.05). The incidence of MACE was significantly lower in the dapagliflozin group compared to the control group (p < 0.05). CONCLUSION: Dapagliflozin was associated with significant improvements in cardiac function, biomarker profiles, and enhanced overall prognosis in older female patients with HFpEF. Meanwhile, dapagliflozin can significantly improve the quality of life in patients with HFpEF. These findings support its therapeutic potential in attenuating ventricular remodeling and optimizing long-term clinical management in this population.