Left Ventricular Systolic Function After 3 Months of SGLT2 Inhibitor Therapy in Heart Failure Patients with Reduced Ejection Fraction

Abstract

Not much is known about the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on echocardiographic parameters of left ventricular (LV) systolic function in patients with heart failure and reduced ejection fraction (HFrEF). We prospectively included 59 outpatients with HFrEF: 41 patients received SGLT2i with OMT (SGLT2i+ group), whereas eighteen patients received OMT without SGLT2i (SGLT2i− group). Myocardial work index (MWI), 3D ejection fraction (3D LVEF), and global longitudinal strain (GLS) were measured at baseline and after 3 months following treatment. At 3-month follow-up, the SGLT2i+ group showed significantly greater improvement in MWI than the SGLT2i− group. In both groups, there was a significant improvement in 3D LVEF and LV GLS, circulating NT-proBNP levels, and NYHA functional class, with significantly greater improvement in the SGLT2i+ group. In conclusion, the addition of SGLT2i to fully optimized background medical therapy resulted in a greater improvement of LV systolic function among outpatients with HFrEF. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12265-023-10389-3.

Improvement in Left and Right Ventricular Function after Introduction of SGLT2 Inhibitors in Heart Failure Outpatients with Reduced Ejection Fraction

“…In a retrospective study with a longer follow-up, an improvement in left ventricular (LV) function was observed, but only in patients affected by T2DM [14]. In diabetic and non-diabetic patients, an improvement in ventricular function was observed, but only during a short-term follow-up [15,16]. Interestingly, this study showed an improvement in LV and right ventricular (RV) function.…”

“…Indeed, a recent metanalysis demonstrated the relationship between SGLT2i and an improvement in LV, but not in RV function. Mustapic et al [15,16], in a single-blind randomized study, showed the beneficial effects of SGLT2i on LV and RV function in optimally treated HFrEF patients, but over a short-term follow-up. Over a longer follow-up, the retrospective study of Hwang et al [14] showed an improvement in LV function, but only in patients affected by T2DM who were not taking sacubitril/valsartan.…”

“…However, it could also be relevant that the beneficial effect on cardiac function is mediated by direct and indirect effects such as the improvement in myocardial energetics [10,11], a reduced intramyocardial sodium concentration [11], and increased oxygen delivery related to an increase in haemoglobin [12]. However, there are limited data about the effects of SGLT2i on cardiac function in HFrEF patients [13][14][15][16][17].…”

Sodium Glucose Co-Transporter 2 Inhibitors and the Cardiovascular System: Current Knowledge and Future Expectations

“… 58 Real-world outpatient data suggest that the addition of dapagliflozin to optimal medical therapy of HF with reduced ejection fraction improves advanced echocardiographic parameters including left ventricular global longitudinal strain and myocardial work index. 59 Two-dimensional speckle-tracking echocardiography provides substantial information concerning the early evaluation of the beneficial effects of SGLT2i on myocardial function. 60 …”