Trajectories of Left Ventricular Mass and Wall Thickness in Obesity: Influence of HbA1c and Dapagliflozin Over Six Months

Background Obesity and diabetes contribute synergistically to cardiac remodeling, yet the short-term structural trajectory of the left ventricle (LV) in response to modest metabolic improvement remains unclear. We examined the influence of HbA1c reduction and dapagliflozin exposure on LV mass index (LVMI) and wall thickness patterns in an obese population. Methods In this six-month prospective cohort study at a tertiary center in Saudi Arabia, 104 overweight or obese adults (mean age 65 ± 11 years; 67% female) underwent paired echocardiography and metabolic evaluation. LV geometry was classified as normal, concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH) based on LVMI and relative wall thickness (RWT). Generalized estimating equations and multinomial logistic regression modeled predictors of remodeling, adjusting for age, gender, BMI, HbA1c changes, and exposure to glucose-lowering agents (metformin, sitagliptin, dapagliflozin). Results BMI decreased modestly (34.4 → 34.2 kg/m²; p = 0.006) while HbA1c improved significantly (7.7 → 6.9%; p < 0.001). LVMI paradoxically increased (92.5 → 100.6 g/m²; p = 0.002), and RWT remained stable (0.43 → 0.40; p = 0.22). Female sex and older age predicted concentric hypertrophy. Males showed a shift from CR to EH (p = 0.018). HbA1c reduction was associated with a lower prevalence of abnormal RWT (p = 0.041). Dapagliflozin use correlated with decreased concentric remodeling (p = 0.012) and greater EH prevalence, suggesting improved LV compliance. Conclusions Even short-term metabolic improvement may translate into measurable structural adaptation of the LV. The observed sex-specific remodeling and the favorable geometric trends in dapagliflozin users support an integrated preventive approach targeting metabolic control to mitigate obesity-related cardiac remodeling.