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Sodium-glucose cotransporter 2 inhibitors in patients with transthyretin amyloid cardiomyopathy – results from a patient series
Session:
Comunicações Orais - Sessão 26 - Doenças do Miocárdio
Speaker:
Daniel Inácio Cazeiro
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel Inácio Cazeiro; João R. Agostinho; Pedro Alves da Silva; Joana Brito; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Catarina Gregório; Ana Abrantes; Miguel Azaredo Raposo; Pedro Morais; Isabel Conceição; Dulce Brito; Fausto J. Pinto
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Transthyretin amyloid cardiomyopathy (ATTR-CM) is a disease characterized by the accumulation of insoluble amyloid fibrils composed of misfolded transthyretin protein in the myocardium. Tafamidis 61mg once daily was the first therapy approved for ATTR-CM treatment. However, its beneficial effects on prognosis and quality of life are only apparent after at least 15 months of treatment. </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">Sodium-glucose cotransporter 2 inhibitors</span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121"><strong> </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">(</span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">) were recently proven to be effective on reducing heart failure (HF) admissions in patients (pts) with HF independently of left ventricular ejection fraction. However, the effects of </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> in ATTR-CM patients are not known</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To study the tolerance and clinical effect of SGLT2i therapy on top-of tafamidis 61 mg daily in pts with ATTR-CM. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We performed a retrospective analysis comparing a group of ATTR-CM pts treated with tafamidis 61mg that were started on SGLT2i with a control group composed of pts with ATTR-CM treated with tafamidis 61mg that were not started on </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> . Clinical characteristics, estimated glomerular filtration rate (eGFR), plasma NTproBNP levels, loop diuretic doses and HF admissions were compared within the study group before and after </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> start, and between both groups. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Twenty-four pts were enrolled (median age 82 years; 92% male). The study group included 14 pts and the control group included 10 pts. The mean follow-up (FUP) time was 5 months (IQR 3-7months).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the study group, after </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> initiation a significant decrease in NYHA functional class was noted (before: NYHA I – 1pts; NYHA II – 10pts; NYHA III – 3pts vs. after: NYHA I – 2pts; NYHA II – 12pts; p=0.046). eGFR, NTproBNP and diuretic doses did not change after therapy initiation. However, only one HF admission was registered in the 5 months before </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> initiation and none afterwards. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Comparing the study group with the control group no significant differences were found regarding NYHA functional class, EGFR, NTproBNP or diuretic doses at FUP. However, at the beginning of FUP pts of the control group seemed to present a milder form of HF when considering NTproBNP, although this difference was not statistically significant (NTproBNP: 793pg/ml, IQR 360-3664 vs. 1208pg/ml, IQR 764-3302). In the control group, one pt had two HF admissions. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion </strong></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Despite the small sample size, the present study showed that </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> may be associated with NYHA functional class improvement in patients with ATTR-CM related HF. Despite no impact on HF admissions in this study, </span></span></span><span style="font-size:11pt"><span style="font-family:'Quattrocento Sans',sans-serif"><span style="color:#212121">SGLT2i</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> may have a potential role in ATTR-CM treatment, and studies with larger populations are needed.</span></span></span></p>
Slides
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