SGLT2 inhibitors therapy in patients with acute Takotsubo syndrome

SGLT2 inhibitors are approved for heart failure treatment, however, few data are available in patients with takotsubo syndrome (TTS). We aim to evaluate the safety, tolerability and effects of SGLT2 inhibitors therapy on myocardial recovery and inflammation in acute TTS.

We compared n = 22 SGLT2 inhibitors treated TTS patients (Dapagliflozin n = 13, Empagliflozin n = 9) with n = 44 1:2 propensity-score matched untreated. Treated patients were mostly consecutively enrolled after implementation of 2023 ESC heart failure guidelines. All underwent cardiac magnetic resonance (CMR) imaging with T2 mapping within 7 days of hospital admission. SGLT2 inhibitors were first administered within 6 h of admission. The primary endpoint was myocardial edema burden as measured by CMR septal T2 mapping. Secondary endpoints were global T2 mapping and left ventricular ejection fraction (LVEF).

After matching, all variables associated with recovery of LV function and edema were proportionally distributed between groups, including age, sex, echocardiographic LVEF on admission, comorbidities and time from admission to CMR imaging. At CMR imaging, treated patients showed similar basal (p = 0.956) while significantly lower septal (56 ms vs 59 ms, p = 0.034) and global (55 ms vs 57 ms, p = 0.049) T2 mapping values, and higher LVEF (55% vs 50%, p = 0.048) compared to controls. We observed no drug-related adverse effects during hospitalization, discontinuation rate at follow-up was 4.5%.

In acute TTS, SGLT2 inhibitors treatment was safe and well tolerated. CMR within one week of hospitalization showed lower myocardial edema burden and higher LVEF in SGLT2 inhibitors treated patients, suggesting quicker recovery of myocardial function.