Effect of Dapagliflozin Administration on the Apoptosis Levels and Myocardial Work of Patients with Acute Myocardial Infarction (DAPOPTOSIS-MI) – A Randomized Controlled Trial

Yoga Yudhistira (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)
Ahmad Yasa (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)
Risalina Myrtha (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)
Habibie Arifianto (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)
Alfa Alfin Nursidiq (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)
Trisulo Wasyanto (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)
Heru Sulastomo (Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia)

Indonesian Journal of Cardiology
Online First

Background: Acute myocardial infarction (AMI) is a common cardiovascular disease and a leading cause of morbidity and mortality. Cellular death during AMI involves apoptosis (80%) and necrosis (20%). Apoptosis contributes to infarct size, Left Ventricular (LV) remodeling, and heart failure post-AMI. Previous studies suggest that dapagliflozin can reduce myocardial apoptosis, marked by decreased caspase-3 levels (preclinical study) and echocardiographic parameters (preclinical and clinical studies). However, human studies evaluating the effects of dapagliflozin on caspase-3 and myocardial work (MW) in AMI patients are not yet available. This study aims to evaluate the effect of dapagliflozin administration on caspase-3 levels and MW in AMI patients. Methods: This was a single-center experimental study with a double-blind randomized controlled trial (RCT) design conducted among 40 AMI patients at Dr. Moewardi General Hospital, Surakarta (September–November 2024). Patients were divided into two groups: dapagliflozin and placebo. Caspase-3 levels and MW parameters (Global Work Index [GWI], Global Constructive Work [GCW], Global Wasted Work [GWW], Global Work Efficiency [GWE]) were measured at admission before and on day 14 post-treatment. Statistical analysis was performed using independent t-tests or Mann-Whitney tests, with p < 0.05 considered significant. Results: The mean pre-test caspase-3 levels were not significantly different between the intervention group, 51.05±36.53ng/ml, and the control group, 56.44±31.01ng/ml (p=0.618). However, post-test caspase-3 levels showed a significant difference: intervention group, 29.55±28.33 ng/ml, compared with control group, 51.97±31.16 ng/ml (p=0.007). There were no significant differences in the pre-test or post-test MW parameters between the two groups (p>0.05). Conclusions: There was a significant reduction in caspase-3 levels in AMI patients following dapagliflozin administration compared to placebo. However, there was no significant improvement in the MW parameters.