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Sodium-glucose cotransporter-2 inhibitor use in patients with a Fontan circulation

Stephanie S Gaydos1, Kimberly E McHugh1, Frances K Woodard1

  • 1Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.

Cardiology in the Young
|February 26, 2025
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors appear safe for treating congestive heart failure in Fontan circulation patients. This study found good tolerability, with few discontinuations, suggesting potential benefits for this unique population.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Congestive heart failure (CHF) in Fontan circulation presents unique challenges compared to biventricular circulation.
  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown efficacy in reducing cardiovascular outcomes in CHF patients with biventricular circulation.
  • Limited data exists on the use and outcomes of SGLT2 inhibitors in patients with Fontan circulation.

Purpose of the Study:

  • To evaluate the safety and tolerability of SGLT2 inhibitors in patients diagnosed with Fontan circulation and CHF.
  • To assess the impact of SGLT2 inhibitors on clinical outcomes in this specific patient group.

Main Methods:

  • A single-center review was conducted on patients with Fontan circulation who were prescribed SGLT2 inhibitors for CHF.
  • The primary outcome measured was the tolerability of the medication and the need for discontinuation.
  • Secondary outcomes included changes in New York Heart Association class, CHF hospitalizations, ventricular function, exercise capacity, and laboratory markers.

Main Results:

  • Twenty-five patients with Fontan circulation (most with a systemic right ventricle) were identified.
  • Over one-third had baseline moderate-to-severe ventricular dysfunction; 59% exhibited occult diastolic dysfunction.
  • SGLT2 inhibitors were generally well-tolerated, with only two discontinuations due to perceived side effects; no significant changes were observed in secondary outcomes, though trends suggested potential benefits.

Conclusions:

  • SGLT2 inhibitors demonstrate safety and tolerability as a CHF therapy in patients with Fontan circulation.
  • This study represents the largest published series on SGLT2 inhibitor use in this population.
  • Further research is recommended to fully understand the therapeutic potential of SGLT2 inhibitors in the unique context of Fontan circulation.
Abstract

Keywords:
Fontanheart failuresodium-glucose cotransporter-2sodium-glucose cotransporter-2 inhibitors

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