To evaluate and follow-up left atrial volume, diastolic function by 2D echocardiography and left atrial strain parameters using speckle-tracking echocardiography in patients with type 2 diabetes mellitus (T2DM) before and after treatment with SGLT2 inhibitors

Diabetes mellitus (DM) is a chronic metabolic disorder that significantly increases cardiovascular morbidity and mortality. Among the earliest manifestations of diabetic heart disease is subclinical cardiac dysfunction, which includes left atrial (LA) remodeling and impaired LA function.

LA remodeling encompasses changes in atrial size, geometry, wall stress, and mechanical function, and serves as an early marker of diastolic dysfunction and elevated left ventricular (LV) filling pressures.

These changes are key contributors to the development of heart failure, particularly heart failure with preserved ejection fraction (HFpEF)[4]and is closely associated with an increased risk of atrial fibrillation (AF).

Conventional echocardiographic parameters often fail to detect early LA dysfunction. Recent advances have highlighted left atrial strain-measured via speckle tracking echocardiography (STE)-as a more sensitive and early marker of LA dysfunction . LA strain assessment, especially during the reservoir, conduit, and contraction phases, provides insights into atrial compliance, stiffness, and overall diastolic function, often preceding structural alterations.

Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors are a class of antihyperglycemic agents that have demonstrated significant cardiovascular benefits in clinical trials. Beyond glycemic control, these agents have been linked to favorable cardiac remodeling, improved diastolic function, and reduced filling pressures. However, their impact on LA function, particularly as assessed by strain parameters, remains underexplored

Inclusion Criteria:

• Diagnosed T2DM on antidiabetic medication not including SGLT2 inhibitors.
• HbA1c ≤ 7%.
• Age 40-75 years.
• Sinus rhythm.
• Informed consent obtained

Exclusion Criteria:

• History of atrial fibrillation or flutter.
• Patients treated with SGLT2 inhibitors.
• Severe mitral valve regurgitation or stenosis.
• Previous myocardial infarction.
• Previous percutaneous coronary intervention(PCI) or coronary artery bypass grafting (CABG).
• LV Ejection fraction <50% .
• Severe renal impairment (eGFR < 30 mL/min/1.73 m²)
• Uncontrolled hypertension (BP > 160/100 mmHg)
• Inadequate echocardiographic windows or incomplete data

Adults aged 40-75 years with a diagnosis of T2DM on stable antidiabetic therapy not including SGLT2 inhibitors