Pulmonary artery pressure trajectories in heart failure patients treated with GLP-1 receptor agonists

Data support favourable haemodynamic benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on improving cardiac structural abnormalities and function in patients with heart failure (HF). However, the direct haemodynamic effects of GLP-1 RAs remain inadequately characterized. We aim to investigate temporal trends of pulmonary artery pressure (PAP) in HF patients receiving GLP-1 RAs.

In this single-centre retrospective cohort study, we identified HF patients with a CardioMEMS device who received semaglutide or tirzepatide for at least 6 months during the monitoring period. Patients who were already on GLP-1 RAs prior to device implantation were excluded. The relationship between weight change and PAPs was assessed using Pearson correlation. A total of nine patients were included (54 years, BMI 41.4 kg/m², 67% men, 44% with EF < 40%, 89% diabetes, 89% semaglutide). Median dose of semaglutide (or equivalent) at 6 months was 0.9 (range 0.25-1) mg/week. Body weight significantly decreased from 123.6 to 117.2 kg (P = 0.047), while guideline-directed medical therapy (GDMT) and loop diuretic uses and dosages remained unchanged. Significant reductions were observed in systolic PAP (38.9 to 34.0 mmHg, P = 0.045), diastolic PAP (20.0 to 17.8 mmHg, P = 0.019) and mean PAP (27.3 to 24.3 mmHg, P = 0.018). There was a significant correlation between weight loss and reductions in systolic PAP (r = 0.69, P = 0.04) and mean PAP (r = 0.72, P = 0.029).

GLP1-RA use in HF patients was significantly associated with reductions in body weight and PAPs at 6 months, despite no changes in GDMT and loop diuretic doses.