SPC365

Does dapagliflozin improve cardiopulmonary performance of non-diabetic heart failure patients?

Session: Comunicações Orais (Sessão 20) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker: Ana Rita Teixeira

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.5 Chronic Heart Failure – Prevention
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita Teixeira; João Ferreira Reis; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira da Silva; Ana Teresa Timóteo; Pedro Rio; Sofia Silva; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:black">Background: Sodium-glucose co-transporter 2 inhibitors have shown to reduce events in Heart Failure (HF) with reduced Ejection Fraction patients &ndash; HFrEF. The cardiopulmonary exercise test (CPET) is a powerful predictor of mortality in this setting. Our aim was to assess whether Dapagliflozin improves cardiopulmonary performance of non-diabetic HF patients </span></span><span style="font-size:11.0pt"><span style="color:black">(Ps)</span></span><span style="font-size:11.0pt"><span style="color:black"> in a real-word setting. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:black">Methods: Adult HF Ps were randomized 1:1 to receive dapagliflozin 10 mg or placebo. All Ps had a LVEF &lt; 50%, were in NYHA class II-III and under guideline-recommended OMT for the previous 3 months, including a BB, ARNI/ACEi and MRA. They were excluded if they had a previous history of diabetes mellitus or a GFR &le; 30ml/min. Baseline and 6-month post-treatment measurements of CPET were evaluated.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:black">Results: 40 Ps were included </span></span><span style="font-size:11.0pt"><span style="color:black">(82.5% male, mean age of 61&plusmn;13years, mean LVEF 34&plusmn;5%, 70% with ischemic etiology). In the 20 Ps randomized to dapagliflozin, no major safety events were recorded, and the reported compliance was 100%. There were no significant differences between groups regarding baseline clinical and demographic characteristics. The mean </span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">respiratory exchange ratio (RER) was 1.10</span></span></span><span style="font-size:11.0pt"><span style="color:black">&plusmn;0.11 and the mean </span></span><span style="font-size:11.0pt"><span style="color:black">peak oxygen consumption (pVO<sub>2</sub>) was 16.4</span></span><span style="font-size:11.0pt"><span style="color:black">&plusmn;4.5 ml/kg/min. </span></span><span style="font-size:11.0pt"><span style="color:black">Treatment with dapagliflozin led to a significant increased pVO<sub>2</sub>: </span></span><span style="font-size:11.0pt"><span style="color:black">3.09&plusmn;3.81 vs 0.11&plusmn;3.29 mL/kg/min, <em>p</em> = 0.030. There was also a </span></span><span style="font-size:11.0pt"><span style="color:black">reduction in VE/VCO<sub>2 </sub>slope (-0.81</span></span><span style="font-size:11.0pt"><span style="color:black">&plusmn;5.92 vs</span></span><span style="font-size:11.0pt"><span style="color:black"> 3.33</span></span><span style="font-size:11.0pt"><span style="color:black">&plusmn;4.02, p= 0.027). In both groups there was an increase in RER</span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">, which was more significant in Ps taking dapagliflozin (</span></span></span><span style="font-size:11.0pt"><span style="color:black">0.10&plusmn;0.09 vs </span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">0.02</span></span></span><span style="font-size:11.0pt"><span style="color:black">&plusmn;0.11, p= 0.027). </span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">No statistically significant difference was found in CPET duration (p=0.225), heart rate recovery (p=0.452), peak heart rate (p=0.240), and peak systolic blood pressure (p=0.094) or any other CPET parameter.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:black">Conclusion: </span></span><span style="font-size:11.0pt"><span style="color:black">Dapagliflozin use led to a significant improvement of cardiorespiratory fitness at 6-months follow-up in non-diabetic HFrEF Ps, improving several CPET variables with established prognostic value in HFrEF.</span></span></span></span></p>