Background: Left atrial ejection force (LAEF) represents the force exerted by the left atrium (LA) to push blood into the left ventricle (LV) at the end of diastole. It is calculated as LAEF = 1/3 × mitral orifice area × (peak A velocity)2.

Methods: The primary endpoint was to assess changes in LAEF after 6 months of sodium-glucose co-transporter-2 inhibitor (SGLT-2 inhibitor) therapy in patients with heart failure with preserved ejection fraction (HFpEF). Secondary endpoints include changes in diastolic function, LV global longitudinal strain (LV-GLS), and LA strain parameters.

Results: In this single-center, prospective, randomized open-label study, 100 HFpEF patients were divided into 2 groups (n = 50 each). The study group received Dapagliflozin 10 mg daily along with guideline-directed medical therapy (GDMT) for 6 months, while the control group received only GDMT. The study group showed a significant reduction in LAEF (143.74 ± 10.33 to 134.4 ± 8.82; P < .001), LV-GLS improvement (−15.9 ± 4.13 to −17.1 ± 3.53; P < .001), and enhanced LA strain parameters (LA reservoir strain: 28.74 ± 9.31% to 36.39 ± 12.3%; LA contractile strain: −12.8 ± 5.41 to −17.89 ± 6.85; LA conduit strain: −15.97 ± 5.49 to −22.5 ± 8.25; all P < .001). Additionally, left ventricular mass index (199.9 ± 21.17 to 186.24 ± 16.77; P < .001) and left atrial volume index (36.17-32.21 mL/m2; P < .001) significantly decreased.

Conclusion: Dapagliflozin significantly reduces LAEF while improving LA strain and LV-GLS, reinforcing its role in LA and LV reverse remodeling in patients with HFpEF.