Switch to gliflozins and biventricular function improvement in patients with chronic heart failure and diabetes mellitus

Abstract

BackgroundSGLT2 inhibitors have been shown to reduce hospitalization in patients with chronic heart failure (CHF). The cardioprotective mechanisms of gliflozins however have not been fully elucidated. Aim of this study was therefore to evaluate the effect of SGLT2 inhibitors on right and left ventricular function in patients with diabetes and HF.MethodsSeventy‐eight patients with diabetes and CHF were enrolled in the study and followed up; 38 started treatment with SGLT2i, while the remaining 40 continued their previous antidiabetic therapy. All patients underwent conventional, TDI and strain echocardiography in an ambulatory setting, at the beginning and after 3 months of therapy with SGLT2i.ResultsAfter 3 months of therapy with SGLT2i, echocardiographic parameters assessing both left and right ventricular dimensions and function were found as significantly improved in patients switching to SGLT2i than control group: LVEF (45±9% vs 40±8%, p<0.001), LVEDD (54±6.5 vs 56±6.5 mm, p<0.01), GLS (‐13±4% vs ‐10±3%, p<0.001), TAPSE (21±3 vs 19±3 mm, p<0.001), RV S’ (13±2.5 vs 11±2, p<0.001), and PAsP (24±8 vs 31±9 mmHg, p<0.001). Also mitral (1.0±0.5 vs 1.3±0.5, p<0.01) and tricuspid regurgitation (1.0±0.5 vs 1.3±0.5, p<0.01) improved after SGLT2i therapy. Changes were not statistically significant in patients not treated with SGLT2i (p n.s. in all cases).ConclusionsIn a real‐world scenario, treatment with SGLT2i in patients with CHF and diabetes is associated with an improvement in both left and right ventricular function assessed at echocardiography. These data may explain potential anti‐remodelling effects of gliflozins.This article is protected by copyright. All rights reserved.

Effects of SGLT2 inhibitors on right ventricular function in heart failure patients: Updated meta-analysis of the current literature

“…This meta-analysis included 1 randomized controlled trial and 6 prospective and 1 retrospective observational stu dies consisting of 370 patients. The majority of patients in the study population were male, and the mean (SD) age was 64.3 (9.9) [1,2,6,[8][9][10][11]. In terms of bias, both randomized controlled trials (Figure 2A) and observational studies (Figure 2B) had a low risk of bias except for one prospective observational study conducted by Kotinas et al [7], which had a moderate risk of bias due to the higher rates of missing values in the follow-up.…”