# Effects of dapagliflozin on main pulmonary artery diameter in patients undergoing mitral valve replacement: a retrospective observational study

## TL;DR

This study found that dapagliflozin use before mitral valve surgery was linked to smaller changes in pulmonary artery size, possibly due to direct vascular benefits.

## Contribution

The study is the first to show dapagliflozin's effect on pulmonary artery diameter during mitral valve replacement surgery.

## Key findings

- Dapagliflozin group had significantly smaller MPA diameter changes compared to controls (p=0.035).
- No significant changes in pulmonary artery pressure or ventricular function in dapagliflozin group.
- Dapagliflozin's benefits appear to be non-pressure-dependent vascular protective effects.

## Abstract

To investigate the effect of preoperative use of the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin on the perioperative main pulmonary artery (MPA) diameter in patients undergoing mitral valve replacement (MVR).

This retrospective study analyzed 196 patients who underwent MVR at the Affiliated Hospital of Qingdao University between April 2020 and April 2025. Based on preoperative dapagliflozin use, patients were divided into a Dapagliflozin group (n = 39) and a Control group (n = 157). The baseline characteristics, perioperative echocardiographic parameters, and percentage changes in serological markers were compared between the two groups.

The baseline characteristics were balanced between the two groups. Postoperatively, the percentage change in MPA diameter was significantly lower in the Dapagliflozin group (−4.09% ± 16.77%) compared to the Control group (−2.21% ± 10.92%), with a statistically significant difference (p = 0.035). However, there were no significant differences in the percentage changes in pulmonary artery systolic pressure (PASP), left ventricular ejection fraction (LVEF), right ventricular function (TAPSE), right ventricular basal diameter (RVBD), or N-terminal pro-B-type natriuretic peptide (NT-proBNP).

In patients undergoing mitral valve replacement, perioperative application of dapagliflozin was independently associated with a more stable and smaller main pulmonary artery diameter. This structural benefit was dissociated from changes in estimated pulmonary artery systolic pressure, suggesting that dapagliflozin may exert positive effects on the pulmonary artery via non-pressure-dependent direct vascular protective mechanisms.