Abstract:Objective To explore the application value of dapagliflozin combined with exercise-based cardiac rehabilitation（CR） in heart failure with mid-range ejection fraction （HFmrEF） patients with type 2 diabetes mellitus（T2DM）. Methods A total of 150 HFmrEF patients with T2MD admitted to Nanjing Chest Hospital from January 2019 to January 2021 (3 cases were lost to follow-up) were randomly divided into control group（n=50）, dapagliflozin group（n=49） and dapagliflozin combined with CR group （combined group，n=48）. The conventional drugs were used for heart failure（HF）in control group, dapagliflozin was added based on conventional drugs in dapagliflozin group, and exercise-based CR was performed in combined group on the basis of dapagliflozin and routine drugs. The patients were followed up for 12 months. The exercise tolerance, Minnesota living with heart failure questionnaire（MLHFQ）, markers in HF, left ventricular ejection fraction（LVEF）, left ventricular internal dimension, diastolic（LVIDd）, left ventricular internal dimension, systolic（LVIDs） and the levels of inflammatory factors were compared after treatment among three groups. Results After treatment, the clinical effective rate increased in the order of control group（64.00%）, dapagliflozin group（77.55%） and combined group（89.58%）（χ²=9.034, P=0.011）. The 6-minute walking test distance（6MWD） and MLHFQ were significantly improved in three groups, and in the order of control group→dapagliflozin group→combined group, 6MWD increased and MLHFQ decreased (P<0.05). The levels of serum soluble growth stimulating gene 2 protein（sST2）, N-terminal B-type natriuretic peptide precursor（NT-proBNP）, hs-CRP and IL-6 decreased significantly after treatment in three groups, and decreased in the order of control group → dapagliflozin group → combined group (P<0.05). LVEF increased in three groups after treatment and was statistically higher in combined group than those in dapagliflozin group and control group respectively（P＜0.05）. LVIDd and LVIDs reduced in three groups after treatment，but only there was a difference in them between pre-treatment and post-treatment in combined group（P＜0.05）,〖JP2〗and they in combined group were statistically lower than those in dapagliflozin group and control group respectively（P＜0.05）. The HF readmission rate and the incidence of major adverse cardiovascular events also decreased in the order of control group→dapagliflozin group→combined group（P＜0.05）. Conclusion Dapagliflozin combined with exercise-based CR has a high clinical value for the HFmrEF patients with type 2 diabetes mellitus.