Objective:

To evaluate the effects of long-term SGLT2i treatment (≥6 months) on left ventricular global longitudinal strain (GLS), diastolic function parameters, and serum fibrosis markers in patients with HFpEF, and to explore potential mechanisms.

Approach:

• Study Design: Retrospective cohort study involving 185 patients with HFpEF, divided into SGLT2i group (n = 93) and control group (n = 92).
• Data Collection: Demographic data, echocardiographic parameters, and serological indicators were collected at baseline and during follow-up (median 12 months).
• Statistical Analysis: Independent sample t-tests, Mann–Whitney U tests, chi-square tests, Pearson correlation analysis, multivariate linear regression, and Kaplan–Meier method were used for analysis.

Key Findings:

• GLS improved significantly in the SGLT2i group (ΔGLS: -2.49% ± 0.54% vs. -0.44% ± 0.52%, P < 0.001).
• NT-proBNP decreased by 30.4% in the SGLT2i group vs. 9.7% in the control group (P < 0.001).
• Heart failure rehospitalization rate was significantly lower in the SGLT2i group (24.7% vs. 55.4%, P < 0.001).
• ΔGLS was significantly positively correlated with ΔPⅢNP (r = 0.554, P < 0.001).
• SGLT2i treatment was identified as an independent predictor of GLS improvement (β= -2.05, P < 0.001).

Interpretation:

Long-term SGLT2i treatment significantly improves myocardial strain, diastolic function, and clinical outcomes in patients with HFpEF, closely related to the reduction of myocardial fibrosis markers.

Limitations:

• Retrospective design may introduce bias.
• Single-center study limits generalizability.
• Follow-up duration may not capture long-term effects.

Conclusion:

SGLT2i therapy significantly improves myocardial strain and diastolic function in HFpEF patients, closely related to the reduction of myocardial fibrosis markers.