Cardiac reverse remodeling after SGLT2i therapy: beyond the sex

Le résumé fourni par la source

Abstract Background Sodium-Glucose Transport Protein 2 Inhibitors (SGLT2i) have proven beneficial cardiac reverse remodeling effects in heart failure (HF) regardless the ejection fraction (EF). The imaging studies focus mainly on the left ventricle (LV) or atrium (LA) remodeling, with an existing lack in knowledge regarding the right ventricle (RV). In addition, there are no studies analysing the effect of sex on SGLT2i’s cardiac remodelling. Purpose To explore the cardiac reverse remodeling in a group of HF patients before and after 6 months from SGLT2i therapy initiation and to investigate the influence of sex on cardiac reverse remodeling. Methods We enrolled HF patients naive to SGLT2i prior therapy commencing (on top to the maximum of HF tolerated therapy). Data were collected before therapy (T0) and at 6 months (T1). The LV, LA and RV dimensions and function were evaluated with both standard and advanced echocardiographic parameters, including ejection fraction (EF), fractional area change (FAC), global longitudinal and circumferential strain (GLS and GCS). The LV filling pressure were estimated basing on the ratio between mitral pulse Doppler E wave velocity and the mean of e’ tissue Doppler velocity between septum and lateral wall (E/e’). The NYHA Class and pro-BNP values were also collected. Patients were then divided according to sex. Results Forty-nine patients were recruited (mean age 73±12 y.o., 69% male and 31% female). Comparing echocardiographic parameters at T0 and T1, a significant reduction in both systolic and diastolic LV volumes along with a significant improvement in LV EF, GLS and GCS were detected. Furthermore, we found a significant increase of LA-EF and GLS, RV-GLS and FAC. A significant reduction of NYHA Class (NYHA > 2 = 35,7% at T0 vs 20,7% at T1; p 0,006) and pro-BNP values were observed (pro-BNP median value 912 (425 – 2308) pg/ml at T0 vs 556 (271 - 915) pg/ml at T1 (p =0,039). The analysis based on sex revealed a similar improvement of the LV volumes, EF, GLS and GCS. Regarding LA and RV, male showed a reverse remodeling comparable to the entire population, while female, although confirming a similar trend, did not reach the statistical significance (limited cohort). Conclusions After 6 months of therapy with SGLT2i, HF patients showed a significant improvement in LV, LA and RV function, and a decrease of pro-BNP values. The sex analysis showed a similar tendency of reverse cardiac remodeling in the two sexes, although in female LA and RV improvement did not reach statistical relevance. These data suggest that SGLT2i determined a global cardiac reverse remodeling, regardless of sex. Table 1 Table 2

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.