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SGLT2 inhibitor therapy in patients with advanced heart failure and reduced ejection fraction

Vincenzo Nuzzi1, Paolo Manca1, Francesca Parisi1

  • 1Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.

Current Problems in Cardiology
|August 29, 2024
PubMed

Insights

Sodium-glucose cotransporter inhibitors (SGLT2-i) show limited benefit in advanced heart failure with reduced ejection fraction (HFrEF). These SGLT2-i did not improve NTproBNP levels or clinical outcomes in advanced HFrEF patients, though they were well-tolerated.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Sodium-glucose cotransporter inhibitors (SGLT2-i) are established treatments for heart failure with reduced ejection fraction (HFrEF).
  • Limited data exists on SGLT2-i efficacy in patients with advanced HFrEF.

Purpose of the Study:

  • To evaluate the effect of SGLT2-i in advanced HFrEF compared to non-advanced HFrEF.
  • To assess the impact of SGLT2-i on N-terminal pro-brain natriuretic peptide (NTproBNP) levels and clinical parameters in these populations.

Main Methods:

  • A cohort of 105 HFrEF outpatients initiating SGLT2-i were divided into advanced and non-advanced HF groups.
  • Primary outcome: NTproBNP trend. Secondary outcomes: New York Heart Association (NYHA) class, glomerular filtration rate (GFR), and left ventricular ejection fraction (LVEF) changes.
  • Multivariate analysis assessed the association between advanced HF and NTproBNP reduction.

Main Results:

  • Advanced HFrEF patients showed an increase in NTproBNP, while non-advanced patients had a significant reduction (-32%).
  • Improvements in LVEF and NYHA class were observed only in the non-advanced group.
  • Advanced HF diagnosis was independently associated with a lower probability of NTproBNP reduction (OR 0.041, p=0.031).

Conclusions:

  • SGLT2-i do not significantly impact NTproBNP, LVEF, or NYHA class in patients with advanced HFrEF.
  • SGLT2-i are well-tolerated in advanced HFrEF patients.
  • Current evidence suggests SGLT2-i may not be as effective in advanced stages of HFrEF.
Abstract

Keywords:
Advanced heart failureHeart failure with reduced ejection fractionNatriuretic peptidesSGLT2 inhibitors

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