Effect of Dapagliflozin on Right Ventricular-Pulmonary Artery Coupling After Off-Pump Coronary Atery Bypass Grafting

This prospective, single-center observational study evaluates the effect of dapagliflozin 10 mg/day on right ventricular-pulmonary artery coupling measured by the TAPSE/PASP ratio in 72 patients with left ventricular ejection fraction \

Inclusion Criteria: * Age ≥ 18 years * Elective isolated off-pump coronary artery bypass grafting (OPCAB) * Left ventricular ejection fraction (LVEF) \< 50% documented on pre-operative echocardiography * Written informed consent Exclusion Criteria: * Concomitant valve surgery * Emergency or urgent CABG * Conversion to on-pump during surgery * Perioperative myocardial infarction (as defined by the Fourth Universal Definition of MI) * Cardiogenic shock * More than moderate valvular heart disease * Persistent atrial fibrillation or atrial flutter at the time of echocardiographic examination) * Previous CABG or any prior cardiac surgery * Severe chronic kidney disease (eGFR \< 25 mL/min/1.73 m²) * Contraindication to SGLT2 inhibitors * Inability to obtain adequate echocardiographic windows * Pregnancy or breastfeeding