The benefits of sodium glucose cotransporter 2 inhibitors (SGLT2i) in heart failure (HF) patients with reduced ejection fraction (HFrEF) have been clearly demonstrated by 2 landmark trials, EMPEROR-Reduced (for empagliflozin)1 and DAPA-HF2 (for dapagliflozin), where a marked and early reduction of the composite end point of cardiovascular death and/or HF-related hospitalizations was observed. Moreover, benefits in terms of cardiovascular mortality where subsequently confirmed by a metanalysis by Zannad et al.3 and further investigations aiming to explain mechanistic effects in terms of cardiac remodeling showed positive results in terms of reduction in left ventricular (LV) volumes and improvement in systolic function, particularly for empagliflozin,4, 5, 6 while less evidence exists about dapagliflozin. However, the mechanisms of the observed beneficial effects remain incompletely understood and are probably multifactorial in nature.7

The aim of this study was to evaluate the morphofunctional echocardiographic changes induced by dapagliflozin treatment in stable outpatients with HFrEF who were already on optimized medical therapy (OMT). Additionally, we aimed to determine whether these changes were associated with improvements in plasma levels of natriuretic peptide (NP) during follow-up. A secondary objective was to identify which baseline echocardiographic variables were correlated with NP reduction during follow-up.