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Multi-Chamber Reverse Remodeling and Hemodynamic Force Realignment After SGLT2 Inhibitor Initiation in Real-World
Silvia Prosperi1, Sara Monosilio1, Andrea D'Amato1
1Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy.
Journal of Cardiovascular Development and Disease
|June 25, 2026
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve heart remodeling across all heart chambers in heart failure (HF) patients. This real-world study also found SGLT2i therapy improved hemodynamic forces, indicating better heart-flow coupling, with no significant sex differences.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) demonstrate beneficial effects on cardiac reverse remodeling (RR) in heart failure (HF).
- Existing research often focuses on single-chamber remodeling (left ventricle/atrium), with limited exploration of integrated biventricular and atrial remodeling.
- Real-world data on SGLT2i effects are scarce, particularly regarding myocardial-flow coupling markers like hemodynamic forces (HDFs) and potential sex-related differences.
Purpose of the Study:
- To evaluate multi-chamber cardiac reverse remodeling (RR) following SGLT2 inhibitor initiation in a real-world heart failure (HF) population.
- To assess if changes in hemodynamic forces (HDFs) offer additional functional insights into myocardial-flow coupling beyond conventional echocardiographic indices.
- To descriptively explore potential sex-related differences in echocardiographic remodeling.
Main Methods:
- Enrolled patients with HF (ejection fraction ≤ 45%) treatment-naive to SGLT2i and on stable guideline-directed medical therapy.
- Performed standard and advanced echocardiography (including speckle-tracking and HDFs assessment) at baseline and 6-month follow-up.
- Collected NYHA class and NT-proBNP levels, analyzing data overall and stratified by sex.
Main Results:
- Observed significant reverse remodeling (RR) across all chambers after 6 months: LV-RR (49%), RV-RR (52%), biventricular RR (27%), and LA-RR (21%).
- Hemodynamic forces (HDFs) demonstrated significant realignment, correlating with improved myocardial-flow coupling.
- Reverse remodeling effects were comparable between sexes (p > 0.05), and NT-proBNP levels significantly decreased.
Conclusions:
- SGLT2i therapy in a real-world cohort is associated with significant multi-chamber cardiac reverse remodeling and HDFs realignment.
- Findings support improved myocardial-flow coupling with SGLT2i, offering insights beyond conventional echocardiographic indices.
- Exploratory analyses revealed no significant sex-related differences in remodeling effects, warranting larger, longer-term randomized studies.
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