The Role of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Sarcoid Cardiomyopathy: A Multicenter
Ahmed K Mahmoud1,2, Ibrahim Kamel3, Kamal Awad4
1Internal Medicine Department, Boston Medical Center-Brighton, Boston University School of Medicine, 736 Cambridge St., Boston, MA, 02135, USA. Ahmed.mahmoud1@bmc.org.
Insights
Sodium-glucose cotransporter 2 (SGLT2) inhibitors show improved outcomes for patients with sarcoid cardiomyopathy (SCM) and reduced left ventricular ejection fraction (LVEF). SGLT2 inhibitor use was linked to lower mortality, hospitalizations, and fewer arrhythmic events in this population.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Cardiac sarcoidosis (SCM) presents as heart failure (HF), arrhythmias, and sudden death.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors are established HF treatments.
- The efficacy of SGLT2 inhibitors in SCM is not well-defined.
Purpose of the Study:
- To evaluate the impact of SGLT2 inhibitors on clinical outcomes in patients with SCM and reduced left ventricular ejection fraction (LVEF).
Main Methods:
- A cohort of 636 patients with SCM and LVEF < 50% was identified using the TriNetX research network.
- Patients were stratified based on SGLT2 inhibitor use.
- 12-month outcomes including mortality and hospitalizations were analyzed.
Main Results:
- SGLT2 inhibitor use was associated with significantly lower all-cause mortality (4.1% vs 8.8%) and HF hospitalizations (HR=0.67).
- A reduction in total hospitalizations (HR=0.79) and arrhythmic events (HR=0.59) was observed.
- Improvement in LVEF was noted in patients using SGLT2 inhibitors.
Conclusions:
- SGLT2 inhibitors demonstrate improved outcomes in SCM patients with reduced LVEF.
- These findings support the use of SGLT2 inhibitors for managing SCM-induced heart failure.
Background:
Cardiac involvement in sarcoidosis can manifest as new-onset heart failure (HF) due to inflammatory dilated cardiomyopathy (sarcoid cardiomyopathy [SCM]), conduction abnormalities, ventricular arrhythmias, and sudden death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are known to improve HF outcomes and reduce mortality. Current guidelines endorse dapagliflozin and empagliflozin for HF management. However, their role in SCM is not known. This study evaluates SGLT2 inhibitors in patients with sarcoid cardiomyopathy and reduced left ventricular ejection fraction (LVEF).
Methods:
We utilized the TriNetX research network database from which we formed a cohort of patients with established SCM and a LVEF of less than 50%. Patients were divided into two groups on the basis of the presence or absence of SGLT2 inhibitors in their medical regimen. We analyzed the data for 12-month outcomes, including all-cause mortality, all-cause hospitalization, and HF hospitalization.
Results:
Propensity score matching yielded a total of 636 subjects with balanced baseline characteristics. Mean age was 60 ± 12 years, and 37% were female individuals. At 12 months, SGLT2 inhibitor use was associated with lower all-cause mortality (4.1 versus 8.8%, hazard ratio [HR] = 0.46, p = 0.019), total hospitalizations (HR = 0.79, p = 0.043), and HF hospitalizations (HR = 0.67, p = 0.016). Use of SGLT2 inhibitors was associated with a significant reduction in arrhythmic events (ventricular tachycardia, fibrillation, cardiac arrest, and second- or third-degree heart block) (HR = 0.59, p = 0.007) along with an improvement in LVEF.
Conclusions:
SGLT2 inhibitor use is associated with improved outcomes in SCM with reduced LVEF, including lower mortality, hospitalization, and incidence of arrhythmic events. Our data support the use of SGLT2 inhibitors in this specific HF population.
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