Effects of semaglutide on cardiac structure and function in heart failure with preserved ejection fraction and obesity: a pre-specified cardiac magnetic resonance substudy of the CAMEO-SEMA trial.

In obesity-related HFpEF patients in the CAMEO-SEMA CMR substudy, semaglutide improved left atrial reservoir strain by +5.7% versus placebo at 52 weeks.

• Why it matters: Prior work showed semaglutide improves exertional PAWP, but the cardiac structural and functional changes that could explain these hemodynamic benefits were unclear.
• What they did: In a prespecified randomized substudy of 49 participants (33 semaglutide, 16 placebo; 28 female), CMR was performed at baseline and 52 weeks, within 1 day of invasive exercise hemodynamics. Primary endpoint was change in LA reservoir strain, with LV filling dynamics measured as eFR/EDV.
• The result: Semaglutide also increased eFR/EDV (+0.64 s -1; P<0.0001) and was linked to lower exercise PAWP (LA strain: r=-0.46, P<0.001; eFR/EDV: r=-0.65, P<0.0001), alongside reductions in LV mass and improved right ventricular and biventricular mechanics.

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