{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:18:44Z","timestamp":1785417524889,"version":"3.56.0"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca","award":["ESR-19-14489"],"award-info":[{"award-number":["ESR-19-14489"]}]},{"award":["ESR-19-14489"],"award-info":[{"award-number":["ESR-19-14489"]}],"id":[{"id":"https:\/\/ror.org\/05qqrnb63","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010434","name":"Caixa Banking foundation","doi-asserted-by":"publisher","award":["HR17-00527"],"award-info":[{"award-number":["HR17-00527"]}],"id":[{"id":"10.13039\/100010434","id-type":"DOI","asserted-by":"publisher"}]},{"award":["HR17-00527"],"award-info":[{"award-number":["HR17-00527"]}],"id":[{"id":"https:\/\/ror.org\/03zhx9h04","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Myocardial fibrosis plays a key role in adverse remodeling after ST-segment-elevated myocardial infarction (STEMI). The effect of sodium\u2013glucose cotransporter 2 inhibitors (SGLT2is) on myocardial fibrosis deposition among patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) is unclear. Objectives: To assess the effects of SGLT2is on myocardial fibrosis among patients with STEMI undergoing pPCI. Methods: Patients with STEMI undergoing pPCI with left ventricular ejection fraction \u2264 50% were randomized to dapagliflozin 10 mg or placebo. The primary endpoint was cardiac magnetic resonance (CMR)-derived 6-month changes in remote myocardium extracellular volume (ECV) fraction from baseline. Secondary endpoints included changes in CMR-derived myocardial volumes, change in serum fibrosis biomarker levels, and adverse events. Multivariable adjustment for infarction location and diabetes status was performed as sensitivity. The study was halted prematurely due to slow recruitment. Results: Fifty-two patients underwent randomization between May 2021 and April 2024 and completed follow-up. At 6 months, dapagliflozin resulted in a non-significant reduction in ECV change compared to placebo (\u22120.39 [4.7] vs. 1.43 [5.7]; difference: \u22121.82 [\u22124.86; 1.23]; p-value = 0.235) while also leding to a higher degree of reduction in N-terminal pro-peptide of type III collagen (\u2212177.0 pg\/mL [416.1] vs. 3.6 pg\/mL [553.8]; p-value = 0.208). No significant differences in other biomarkers or adverse events were noted in the main analysis. After adjustment, dapagliflozin was associated with increased reduction in left ventricular end-systolic volume (\u22124.02 mL [7.4] vs. 0.10 mL [10.1]; difference: \u22124.92 [\u22129.8; \u22120.1]; p-value = 0.047). Conclusions: In STEMI patients undergoing pPCI, dapagliflozin did not result in a significant reduction in ECV or biomarkers of fibrosis at 6 months.<\/jats:p>","DOI":"10.3390\/jcm15114061","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T01:45:08Z","timestamp":1779673508000},"page":"4061","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Dapagliflozin on Myocardial Fibrosis After STEMI: A Double-Blind, Placebo-Controlled Randomized Trial"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9567-3253","authenticated-orcid":false,"given":"Luis","family":"Ortega-Paz","sequence":"first","affiliation":[{"name":"Division of Cardiology, College of Medicine, University of Florida, Jacksonville, FL 32206, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-7402","authenticated-orcid":false,"given":"Claudio","family":"Laudani","sequence":"additional","affiliation":[{"name":"Division of Cardiology, College of Medicine, University of Florida, Jacksonville, FL 32206, USA"},{"name":"Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6336-3501","authenticated-orcid":false,"given":"Carlos Igor","family":"Morr","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cardiovascular Clinic Institute, Hospital Cl\u00ednic Barcelona, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Biomedical Sciences, Institut de Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-9512","authenticated-orcid":false,"given":"Alessandro","family":"Sionis","sequence":"additional","affiliation":[{"name":"Cardiological Intensive Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"},{"name":"Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain"},{"name":"Division of Cardiology, Centro de Investigaci\u00f3n en Red de Enfermedades Cardiovasculares (CIBERCV), 28028 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Vidal-Cales","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cardiovascular Clinic Institute, Hospital Cl\u00ednic Barcelona, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9525-1133","authenticated-orcid":false,"given":"Victor","family":"Arevalos","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cardiovascular Clinic Institute, Hospital Cl\u00ednic Barcelona, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Divisi\u00f3n de Medicina Cardiovascular, Hospital de Clinicas, Universidad Nacional de Asunci\u00f3n, Asunci\u00f3n 2169, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8409-5013","authenticated-orcid":false,"given":"Rut","family":"Andrea","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cardiovascular Clinic Institute, Hospital Cl\u00ednic Barcelona, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Biomedical Sciences, Institut de Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8476-7094","authenticated-orcid":false,"given":"Oriol","family":"De Diego","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cardiovascular Clinic Institute, Hospital Cl\u00ednic Barcelona, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Biomedical Sciences, Institut de Investigacions Biom\u00e8diques August Pi i Sunyer 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Rev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1016\/j.jacc.2020.03.024","article-title":"Basic Biology of Extracellular Matrix in the Cardiovascular System, Part 1\/4: JACC Focus Seminar","volume":"75","author":"Fischer","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.ijcard.2016.08.070","article-title":"Utility of Galectin-3 in Predicting Post-Infarct Remodeling after Acute Myocardial Infarction Based on Extracellular Volume Fraction Mapping","volume":"223","author":"Perea","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1016\/j.jacc.2020.03.020","article-title":"Extracellular Matrix in Ischemic Heart Disease, Part 4\/4: JACC Focus Seminar","volume":"75","author":"Frangogiannis","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1056\/NEJMra2115011","article-title":"Gliflozins in the Management of Cardiovascular Disease","volume":"386","author":"Braunwald","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/ehf2.14186","article-title":"Direct Actions of Dapagliflozin and Interactions with Lcz696 and Spironolactone on Cardiac Fibroblasts of Patients with Heart Failure and Reduced Ejection Fraction","volume":"10","author":"Cristobal","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.jcmg.2020.10.017","article-title":"Empagliflozin Reduces Myocardial Extracellular Volume in Patients with Type 2 Diabetes and Coronary Artery Disease","volume":"14","author":"Mason","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ortega-Paz, L., Laudani, C., Sionis, A., Vidal-Cales, P., Arevalos, V., Andrea, R., Morr, C.I., De Diego, O., Ortega, E., and Jimenez-Trinidad, F.-R. (2025). Effect of DAPAgliflozin on Myocardial Fibrosis and Ventricular Function in Patients with ST-Segment Elevation Myocardial Infarction\u2014DAPA-STEMI Trial. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12060220"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction","volume":"381","author":"McMurray","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"EVIDoa2300286","DOI":"10.1056\/EVIDoa2300286","article-title":"Dapagliflozin in Myocardial Infarction without Diabetes or Heart Failure","volume":"3","author":"James","year":"2024","journal-title":"NEJM Evid."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 Esc Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with St-Segment Elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with St-Segment Elevation of the European Society of Cardiology (Esc)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1016\/j.jacc.2024.04.025","article-title":"10-Year Mortality after St-Segment Elevation Myocardial Infarction Compared to the General Population","volume":"83","author":"Thrane","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.amjcard.2021.10.035","article-title":"Heart Failure Incidence Following St-Elevation Myocardial Infarction","volume":"164","author":"Costa","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jcmg.2019.03.017","article-title":"Extracellular Volume Associates with outcomes More Strongly than Native or Post-Contrast Myocardial T1","volume":"13","author":"Treibel","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e009535","DOI":"10.1161\/CIRCIMAGING.119.009535","article-title":"Myocardial Extracellular Volume Fraction Adds Prognostic Information Beyond Myocardial Replacement Fibrosis","volume":"12","author":"Yang","year":"2019","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1161\/CIRCULATIONAHA.119.042375","article-title":"Effect of Empagliflozin on Left Ventricular Mass in Patients with Type 2 Diabetes Mellitus and Coronary Artery Disease","volume":"140","author":"Verma","year":"2019","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jcmg.2021.12.008","article-title":"Diabetes and Myocardial Fibrosis: A systematic review and meta-analysis","volume":"15","author":"Salvador","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0002-9149(99)80686-9","article-title":"Measuring Extracellular Matrix Turnover in the Serum of Patients with Idiopathic or Ischemic Dilated Cardiomyopathy and Impact on Diagnosis and Prognosis","volume":"75","author":"Klappacher","year":"1995","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/j.1365-2125.2005.02363.x","article-title":"Spironolactone Reduces Brachial Pulse Wave Velocity and Piiinp Levels in Hypertensive Diabetic Patients","volume":"59","author":"Davies","year":"2005","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/ejhf.3101","article-title":"Effects of Empagliflozin on Collagen Biomarkers in Patients with Heart Failure: Findings from the Emperor Trials","volume":"26","author":"Ferreira","year":"2024","journal-title":"Eur. J. Heart Fail."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1016\/j.jacc.2019.01.056","article-title":"Empagliflozin Ameliorates Adverse Left ventricular Remodeling in Nondiabetic Heart Failure by Enhancing Myocardial Energetics","volume":"73","author":"Antonio","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s12933-023-01970-w","article-title":"Left Ventricular Remodeling Response to Sglt2 Inhibitors in Heart Failure: An Updated Meta-Analysis of Randomized Controlled Studies","volume":"22","author":"Carluccio","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mederle, A.L., Dumitrescu, P., Borza, C., and Kundnani, N.R. (2024). Cutaneous Adverse Drug Reactions Associated with Sglt2 Inhibitors. J. Clin. Med., 14.","DOI":"10.3390\/jcm14010188"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"787","DOI":"10.4244\/EIJV16I10A147","article-title":"Immediate and Long-Term Impact of the COVID-19 Pandemic on Cardiovascular Clinical Trials: Considerations for Study Conduct and Endpoint Determination","volume":"16","author":"Lansky","year":"2020","journal-title":"EuroIntervention"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4061\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:14:02Z","timestamp":1779768842000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,24]]},"references-count":24,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114061"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114061","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,24]]}}}