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Background: In patients with type 2 diabetes mellitus (T2DM) the vaso-vagal syncope (VVS) recurrence could be due to the alteration of autonomic system function, evaluated by heart rate variability (HRV), and by 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy indexes: Heart to Mediastinum ratio (H/Mlate), and Washout rate (WR). The SGLT2-I could modulate/reduce autonomic dysfunction in T2DM patients with VVS. This effect could reduce the VVS recurrence in T2DM patients. Methods: In a prospective multicenter study, we studied a population of 607 T2DM patients affected by VVS, as SGLT2-I-users (n 161) vs. Non-SGLT2-I users (n 446). Thus, in SGLT2-I-users vs. Non-SGLT2-I users, we investigated the HRV and 123I-MIBG modifications and VVS recurrence at 12 months of follow-up. Results: At baseline, and follow-up end Non-SGLT2-I users vs. SGLT2-I-users over-expressed the inflammatory markers and norepinephrine, with worse glucose homeostasis and significant difference of HRV parameters, H/Mlate, and the WR (plate (0.710, CI 95% [0.481-0.985]; p 0.024), and SGLT2-I (0.550, CI 95% [0.324-0.934]; p 0.027) predicted all VVS recurrence. Conclusions: Non-SGLT2-I users vs. SGLT2-I-users had alterations of the autonomic nervous system, with a higher rate of VVS recurrence at 1 year of follow-up. The indexes of cardiac denervation predicted the VVS recurrence, while the SGLT2-I reduced the risk of VVS recurrence. Clinical trial registration number: NCT03717207. |
