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Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
Nikita Ermolaev1, Robin Willixhofer1, Christoph Krall2
1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
Insights
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improved hemoglobin and hematocrit levels in cardiac amyloidosis (CA) patients. This therapy also stabilized functional capacity, offering potential benefits for this patient group.
Area of Science:
- Cardiology
- Hematology
- Nephrology
Background:
- Cardiac amyloidosis (CA) patients often experience heart failure symptoms and iron deficiency, impacting erythropoiesis.
- Hematopoietic effects of SGLT2 inhibitors (SGLT2i) are known in heart failure (HF), but unstudied in CA.
- Iron deficiency in CA negatively affects hemoglobin and hematocrit levels.
Purpose of the Study:
- To investigate the effects of SGLT2 inhibitors on hematological parameters in CA patients.
- To assess the impact of SGLT2 inhibitors on functional capacity in CA patients.
Main Methods:
- Prospective analysis comparing SGLT2i + best medical therapy (BMT) vs. BMT alone (historical control).
- 20 patients in each group (SGLT2i + BMT vs. BMT).
- Blood tests and cardiopulmonary exercise testing (CPET) at baseline and 6-month follow-up.
Main Results:
- SGLT2i therapy significantly improved hemoglobin (+1.2 mg/dL) and hematocrit (+4.4%) compared to controls.
- Serum iron levels showed improvement in the SGLT2i group.
- Functional capacity, measured by peak VO2 and VE/VCO2 slope, was maintained in the SGLT2i group.
Conclusions:
- SGLT2 inhibitors demonstrate significant hematopoietic benefits in CA patients.
- SGLT2i therapy helps stabilize functional capacity in cardiac amyloidosis.
- SGLT2i represents a promising therapeutic option for managing hematological and functional aspects of CA.
Background:
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been found to have potential hematopoietic effects in patients with heart failure (HF). However, these benefits have not been studied in patients with cardiac amyloidosis (CA). CA patients present with HF symptoms and often suffer from iron deficiency, which has a negative impact on erythropoiesis and leads to lower hemoglobin and hematocrit levels. We sought to determine the potential effects of SGLT2i on hematological parameters and functional capacity (FC) in CA patients.
Methods:
A prospective analysis was conducted to compare the effects of SGLT2i in patients who received the best medical therapy (BMT) along with SGLT2i (n = 20), versus patients receiving only BMT without SGLT2i (n = 20) (historical control group). All patients underwent blood testing and cardiopulmonary exercise testing (CPET) at baseline (BL) and after 6 months [interquartile range (IQR): 4.0 to 8.0].
Results:
The SGLT2i-based therapy resulted in a significant improvement and difference in hematological parameters at 6 months follow-up compared to the control group. In the SGLT2i group, the mean hemoglobin level increased (+1.2 mg/dL), whereas in the control group, it decreased (-0.8 g/dL) (p < 0.001 for overall group comparison). The hematocrit showed a significant increase in the SGLT2i group (+4.4%) compared to a decrease in the control group (-1.8%) (p < 0.001). Additionally, the serum iron level improved in the SGLT2i-treated group (+ 5.5 [-5.0 to 17.5] μg/dL vs. -6.0 [-15.0 to 4.0] μg/dL, p = 0.121). Although there was no significant change in the peak oxygen consumption (peak VO2, (mL/min)/kg) (p = 0.206), as well as in pulmonary ventilation (VE)/carbon dioxide production (VCO2) slope in both groups (p = 0.964), the SGLT2i group maintained a peak VO2 and VE/VCO2 slope throughout the study.
Conclusions:
SGLT2i therapy improved hematological parameters and stabilized the FC of CA patients.
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