SGLT2 inhibitors were well tolerated and significantly reduced NT-proBNP by 2.1% per month in single ventricle patients with moderate ventricular dysfunction.
Does SGLT2i therapy improve NT-proBNP and ventricular function in adults with single ventricle circulatory failure?
SGLT2 inhibitors are well-tolerated and associated with reduced NT-proBNP and improved ventricular function in adults with single ventricle physiology and at least moderately reduced ventricular function.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Patients with a single ventricle physiology are at high risk of developing circulatory failure from an early age. There is limited evidence for pharmacological treatment in these patients. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a promising novel treatment option. Purpose To investigate the safety, tolerability, and efficacy of SGLT2i in patients with single ventricle physiology. Methods A retrospective cohort study was conducted in a subgroup of adults (≥18 years) with single ventricle physiology included in a real-world international registry of adult congenital heart disease patients on SGLT2i. Data on tolerability, side effects, mortality, and NT-proBNP were collected. In patients with a transthoracic echocardiogram at baseline and at least one within the first year of treatment, the effect of SGLT2i on ventricular function was evaluated. Mixed models were used to assess longitudinal changes. Results In total, 35 single ventricle physiology patients were included from 6 participating centres in Europe and the United States. The median age was 33 21–45 years, 20 (57%) were female, 19 (54%) were on dapagliflozin, and 16 (46%) were on empagliflozin. Thirty-four patients (97%) started SGLT2i for circulatory failure and 1 (3%) for type 2 diabetes. At baseline, 14 (40%) had ≥ moderately reduced and 21 (60%) ≤ mildly reduced systolic function (Picture 1). During a median follow-up duration of 8.3 3.4–12.8 months, SGLT2i therapy was permanently discontinued in 3 patients (9%), 6 (17%) experienced side effects, and no patients died. In patients with ≥ moderately reduced ventricular function, NT-proBNP decreased significantly over time (-2.1% per month, p=0.024). In contrast, in patients with ≤ mildly reduced function, NT-proBNP increased over time (2.5% per month, p=0.002) (Picture 2). Thirty-five echocardiograms were available for analysis in 13 patients. A significant improvement in basal lateral segmental strain (-0.3%-point per month, p=0.044) but not in global longitudinal strain was observed (p=0.102). Fractional area change improved significantly in the first 100 days after starting SGLT2i (2%-point per month, p=0.007), and stabilised afterwards (p=0.718). End-systolic area also decreased significantly in the first 100 days (-1.6 cm2 per month, p=0.007), after which there was no significant change (p=0.051). Conclusions SGLT2i were tolerated well with limited side effects in patients with single ventricle physiology. SGLT2i therapy was associated with a reduction in NT-proBNP in patients with at least moderately reduced ventricular function at baseline, whereas NT-proBNP increased over time in those with preserved ventricular function. In a subgroup that underwent detailed echocardiographic analysis, there were signs of improvement in ventricular function during SGLT2i therapy.Baseline characteristics Predicted changes in NT-proBNP
Neijenhuis et al. (Sat,) reported a other. SGLT2 inhibitors were well tolerated and significantly reduced NT-proBNP by 2.1% per month in single ventricle patients with moderate ventricular dysfunction.