{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:31:01Z","timestamp":1786336261489,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Grounded in the \u201cmyocardial metabolic starvation\u201d hypothesis, this study evaluated the pharmacological effects of dapagliflozin on serum metabolic profiles, ventricular remodeling, and cardiac function in patients hospitalized with acute heart failure (AHF), and explored the associations between circulating metabolic alterations, ventricular remodeling, and cardiac functional parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study included 50 AHF patients (25 pairs) after 1:1 propensity score matching. The dapagliflozin group received standard care plus dapagliflozin 10\u00a0mg once daily for 6 months, while the control group received standard care alone. Changes in circulating metabolic parameters, including fasting blood glucose, lactic acid, free fatty acids, and ketone-related metabolites (\u03b2-hydroxybutyrate and acetoacetic acid), as well as glycolytic enzyme activity (pyruvate kinase), were compared between groups. Echocardiographic parameters, 6-min walk test (6\u00a0MWT) distance, B-type natriuretic peptide (BNP), and major adverse cardiovascular events (MACE) were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The dapagliflozin group showed greater reductions in circulating metabolic parameters, particularly fasting plasma glucose, free fatty acids, \u03b2-hydroxybutyrate, and acetoacetic acid, compared with controls (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Left ventricular end-systolic diameter (37.29 \u00b1 4.07 vs. 43.16 \u00b1 4.41\u00a0mm) and end-diastolic diameter (45.17 \u00b1 5.02 vs. 52.63 \u00b1 6.20\u00a0mm) improved more markedly in the dapagliflozin group (both\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). left ventricular ejection fraction (48.36% \u00b1 4.88% vs. 43.85% \u00b1 4.90%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002), BNP (116.45 \u00b1 12.15 vs. 214.50 \u00b1 20.36\u00a0pg\u00a0mL\n                      <jats:sup>-1<\/jats:sup>\n                      , P &amp;lt; 0.001), and 6\u00a0MWT distance (385.56 \u00b1 51.42 vs. 314.78 \u00b1 42.17\u00a0m, P &amp;lt; 0.001) were also significantly superior in the dapagliflozin group. FFA reduction correlated positively with LVEDD reduction (r = 0.638, P &amp;lt; 0.001). Multiple regression analysis identified \u0394FFA (\u03b2 = \u22120.412,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.008) and \u0394\u03b2-HB (\u03b2 = \u22120.385,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.012) as independent predictors of \u0394LVEF improvement. MACE incidence was numerically lower in the dapagliflozin group (8.0% vs. 32.0%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.076).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this small retrospective cohort, early in-hospital initiation of dapagliflozin was associated with favorable changes in circulating metabolic profiles, ventricular remodeling, and cardiac function in patients with acute heart failure. These findings suggest potential therapeutic benefits for ventricular remodeling, but require confirmation in larger prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1913021","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:22:34Z","timestamp":1786335754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic remodeling and cardiac functional adaptation mediated by dapagliflozin in patients with acute heart failure: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Feng","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Jintang County First People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingjun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jintang County First People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuping","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jintang County First People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guobin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jintang County First People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jintang County First People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jintang County First People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faming","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shifang City People\u2019s Hospital","place":["Deyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.echo.2024.10.009","article-title":"Dapagliflozin effects on left ventricular remodeling and filling pressures in heart failure with reduced ejection fraction","volume":"38","author":"Acquaro","year":"2025","journal-title":"J. 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