The effect of extended release metformin on MRI parameters of left ventricular remodeling in patients with prediabetes and heart failure with preserved ejection fraction

Aim. To study the effect of extended release metformin (XR) on MRI parameters of left ventricular (LV) remodeling in patients with prediabetes, heart failure with preserved ejection fraction (HFpEF) and abdominal obesity (AO). Materials and methods. A single-center open-label randomized prospective controlled trial included 64 people (50% men, median age 58 [55.25; 59.75] years) with HFpEF, prediabetes and AO. All patients (groups A and B) received optimal therapy for HFpEF. In group A (n=32), metformin XR 1000–1500 mg/day was prescribed in addition to the optimal therapy of HFpEF. All patients underwent a general clinical examination, standard anthropometry, a 6-minute walk test, a MRI of the heart (Ingenia 3.0T scanner, Philips, the Netherlands) with an assessment of LV myocardial mass (LVM), LV myocardial mass index (LVMI) and epicardial fat thickness. Results. Patients treated with metformin XR on the background of standard HFpEF therapy for 12 months had a decrease in body weight by 4.1% (p=0.001), body mass index (BMI) by 2.0% (p=0.001), as well as glycated hemoglobin levels by 3.3% (p=0.008), relative to baseline values. According to the MRI of the heart, taking metformin XR in group A led to a decrease in indicators: LVM by 2.4% (p=0.002), the magnitude of the change (Δ) of the indicator was -5.3 [-12.0; 2.0] g, LVMI by 1.7% (p=0.002), ΔLVMI was -2.0 [-4.5; 0.9] g/m1.7. No correlation was found between ΔLVMI and ΔBMI (r=-0.034; p=0.857). In group B, the parameters of LVM and LVMI did not differ at visits 1 and 3. The dynamics of epicardial fat thickness according to MRI data was demonstrated only in group A as a decrease of 16.7% (p=0.029). Conclusion. Taking metformin XR for 12 months at a dose of 1000–1500 mg per day in patients with prediabetes, HFpEF and AO against the background of optimal basic HFpEF therapy was associated with a decrease LVM, LVMI and epicardial fat thickness, assessed using cardiac MRI as the gold standard for noninvasive myocardial imaging.