Right Ventricular-Pulmonary Artery Coupling Predicts Early Myocardial Strain Improvement in SGLT2 Inhibitor-Treated...

While sodium-glucose cotransporter-2 (SGLT2) inhibitors clearly benefit left ventricular recovery in heart failure with reduced ejection fraction (HFrEF), their rapid effects on right ventricular (RV) function remain poorly characterized. This prospective observational study investigated the timeline and markers of biventricular changes shortly after SGLT2 inhibitor initiation.

In this prospective observational study, 50 adults with HFrEF (LVEF <40%) on optimal guideline-directed therapy underwent baseline and 3-month assessments after SGLT2 inhibitor initiation. Clinical parameters, functional capacity, and comprehensive echocardiography-including speckle-tracking-were evaluated.

After 3 months, NT-proBNP levels decreased significantly (1116.5 vs 913.5 pg/mL, P < 0.001). Improvements were observed in LV systolic function (LVEF 28.88 vs 30.32%, P = 0.001; LV-GLS -16.35% vs -17.70%, P = 0.001) and RV performance (RVEF 37.76 vs 39.40%, P = 0.002; RVFWS -16.8% vs -18.3%, P = 0.003). These changes were accompanied by gains in functional capacity (6MWT 291.4 ± 31.6 m vs 324.0 ± 36.8 m, P < 0.001) and quality of life (KCCQ-12 44.22 ± 7.88 vs 49.70 ± 8.19, P < 0.001). Improvement in RVFWS correlated strongly with changes in LV-GLS (r = 0.62, P < 0.001), 6MWT (r = -0.67, P < 0.001), and KCCQ-12 (r = -0.62, P < 0.001). Multivariable linear regression identified baseline NT-proBNP (β = 0.253, P = 0.032), ischemic etiology (β = 0.217, P = 0.044), and the TAPSE/PASP ratio (β = -0.510, P < 0.001) as independent predictors of RV strain improvement (model R² = 0.546). ROC analysis demonstrated that a baseline TAPSE/PASP ratio ≥0.39 predicted RV functional response (AUC 0.84; sensitivity 76%, specificity 84%).

In this prospective observational study without a control group, SGLT2 inhibitor initiation was associated with coordinated biventricular improvements within three months in HFrEF patients. The baseline TAPSE/PASP ratio may serve as a useful non-invasive predictor of early RV functional recovery. These preliminary findings require confirmation in larger controlled studies.