Effect of Dapagliflozin on Right Ventricular-Pulmonary Artery Coupling After Off-Pump Coronary Atery Bypass Grafting

Patients undergo echocardiography at three time points: pre-operatively (T0), at 1 month post-surgery before dapagliflozin initiation (T1), and at 7 months post-surgery after 6 months of dapagliflozin 10 mg/day (T2).

The primary objective is to evaluate the change in the TAPSE/PASP ratio from T1 to T2.

Secondary objectives are to evaluate changes from T1 to T2 in:

• Pulmonary artery systolic pressure (PASP)
• Pulmonary vascular resistance (PVR)
• Right ventricular fractional area change (RV FAC)
• Left ventricular ejection fraction (LVEF)
• NT-proBNP levels
• Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) overall summary score

The study aims to provide mechanistic insight into the effects of SGLT2 inhibition on right ventricular-pulmonary artery coupling after off-pump coronary artery bypass grafting.

Inclusion criteria

• Age ≥ 18 years
• Elective isolated off-pump coronary artery bypass grafting (OPCAB)
• Left ventricular ejection fraction (LVEF) < 50% documented on pre-operative echocardiography
• Written informed consent

Exclusion criteria

• Concomitant valve surgery
• Emergency or urgent CABG
• Conversion to on-pump during surgery
• Perioperative myocardial infarction (as defined by the Fourth Universal Definition of MI)
• Cardiogenic shock
• More than moderate valvular heart disease
• Persistent atrial fibrillation or atrial flutter at the time of echocardiographic examination)
• Previous CABG or any prior cardiac surgery
• Severe chronic kidney disease (eGFR < 25 mL/min/1.73 m²)
• Contraindication to SGLT2 inhibitors
• Inability to obtain adequate echocardiographic windows
• Pregnancy or breastfeeding