Background:
Diabetes increases the risk for cardiovascular (CV) events. It has
recently been shown that the use of sodium-glucose cotransporter 2
(SGLT2) inhibitors leads to a reduction in CV outcomes in patients with
type 2 diabetes mellitus (T2DM), including mortality and heart failure
hospitalization. The exact mechanisms of how SGLT2 inhibitors lead to
this CV risk reduction remain incompletely understood. The study of
DAPAgliflozin on CARDiac substrate uptake, myocardial efficiency and
myocardial contractile work in type 2 diabetes patients (DAPACARD)
(NCT03387683) explores the possible effects of dapagliflozin, an SGLT2
inhibitor, on cardiac work, metabolism, and biomarker levels.

Methods:
DAPACARD is an international, randomized, double-blind trial that aims
to examine the effects of dapagliflozin versus matching placebo in 52
patients with T2DM that are on stable metformin therapy prior to and
during the 6 weeks of treatment. The primary efficacy endpoint is change
in global longitudinal strain of the left ventricle (GLSLV) measured
with magnetic resonance imaging (MRI) between baseline (pre-treatment)
and end of study (on-treatment). The secondary endpoint is the
corresponding change in myocardial efficiency measured as external left
ventricular work divided by total left ventricular work, which is
estimated using [11C]-acetate clearance using positron emission
tomography (PET).

Conclusion:
The DAPACARD study is an extensive investigation of cardiac function
and metabolism, by advanced imaging with PET and MRI, as well as
biomarkers, performed in order to further explore how the SGLT2
inhibitor dapagliflozin could influence cardiovascular outcomes in
patients with T2DM.