Semaglutide Improves LA Function and LV Filling in HFpEF Patients

Semaglutide improves left atrial function and left ventricular filling dynamics in patients with obesity-related heart failure with preserved ejection fraction, according to a prespecified cardiovascular magnetic resonance substudy of the CAMEO-SEMA trial published on ClinicalTrials.gov under identifier NCT05371496.

Key Clinical Takeaways:

• Semaglutide improved left atrial reservoir strain by 5.7% compared to placebo over 52 weeks.
• Early filling rate indexed to end-diastolic volume increased by 0.64 s−1 in the treatment group.
• Both markers of improved diastolic function correlated with reductions in exercise pulmonary artery wedge pressure.

Researchers evaluated 49 participants, including 33 receiving semaglutide and 16 receiving a placebo, with 28 participants identifying as female. Each participant underwent cardiovascular magnetic resonance imaging at baseline and again at 52 weeks within one day of an invasive exercise hemodynamic assessment.

The primary prespecified endpoint focused on the change in left atrial reservoir strain. Compared with the placebo group, participants taking semaglutide showed a statistically significant improvement in left atrial reservoir strain with a 95% confidence interval ranging from +0.3 to +9.7 at a P value of 0.037.

Investigators tracked early filling rate indexed to end-diastolic volume as an additional prespecified endpoint. This metric increased by 0.64 s−1 with a 95% confidence interval from +0.42 to +1.00 at a P value below 0.0001 in the semaglutide cohort.

Improvements in both left atrial reservoir strain and left ventricular filling dynamics associated directly with reductions in exercise pulmonary artery wedge pressure. The correlation coefficient reached r equals -0.46 for atrial strain and r equals -0.65 for filling dynamics.

Semaglutide treatment reduced left ventricular mass and restored more physiologic left ventricular geometry across the 52-week study period. The therapy also improved right ventricular function and biventricular myocardial mechanics.

Prior research demonstrated that semaglutide reduces exertional pulmonary artery wedge pressure in obesity-related heart failure with preserved ejection fraction. However, the exact structural and functional cardiac changes underlying those hemodynamic improvements remained unclear until this magnetic resonance imaging analysis.

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