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Dapagliflozin's Influence on Cardiac Remodeling in Chronic Heart Failure Patients
Session:
Comunicações Orais - Sessão 15 - Síndrome coronária aguda 2
Speaker:
Ana Rita Teixeira
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Rita Teixeira; André Paulo Ferreira; João Ferreira Reis; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Ana Teresa Timóteo; João Alves; Sofia Barquinha; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Introduction:</span></strong><span style="font-size:11.0pt"> Dapagliflozin improves the prognosis of patients (Ps) with heart failure (HF). <span style="color:black">Adverse myocardial remodeling affecting the left ventricle (LV) is a key factor in HF progression. Our aim was to investigate the impact of dapagliflozin on cardiac remodeling parameters in HF Ps in a real-world setting.</span> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods:</span></strong><span style="font-size:11.0pt"> This single-centre prospective study involved </span><span style="font-size:11.0pt"><span style="color:black">adult HF Ps randomized 1:1 to receive dapagliflozin 10 mg or a placebo. All Ps had a </span></span><span style="font-size:11.0pt">LV ejection fraction (LVEF)</span><span style="font-size:11.0pt"><span style="color:black"> < 50%, were in NYHA class II-III and had been on guideline-recommended OMT for the previous 3 months, including a BB, ARNI/ACEi and MRA. Exclusion criteria included a history of diabetes mellitus or a GFR ≤ 30ml/min/1.73m<sup>2</sup>. Baseline and 6-month post-treatment measurements of echocardiographic parameters were evaluated.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results</span></strong><span style="font-size:11.0pt">: Forty Ps were included (82.5% male, mean age 61±13 years, mean </span><span style="font-size:11.0pt">LVEF </span><span style="font-size:11.0pt">34±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. </span><span style="font-size:11.0pt">During follow-up, Ps under dapagliflozin showed significant remodeling with a decrease in the LV end-diastolic diameter (LVEDD), from 67.2 to 63.0mm vs. from 65.1 to 65.8mm in the control group (<em>p</em>=0.010), while there was no significant difference in the LV end-systolic diameter (LVESD) variation (<em>p</em>=0.460). The dapagliflozin group also demonstrated a significant improvement in global longitudinal strain from -8.2±3.2 to −10.4±2.3 vs −8.4 ± 2.8 to −6.8 ± 2.8, <em>p</em> < 0.001, while no significant difference was observed in LVEF (<em>p</em>=0.512), or right ventricular systolic function assessed by TAPSE (<em>p</em>=0.376). Furthermore, there was also a significant improvement in LV-filling pressures parameters as evidenced by a reduction in left atrium (LA) indexed volume (p<0.001) and an improvement in E/e’ ratio (p=0.026). Ps under dapagliflozin also showed a </span><span style="font-size:11.0pt">statistically significant reduction in pulmonary artery systolic pressure<span style="background-color:white"><span style="color:black"> (p<0.001).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:#222222">Conclusion</span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:#222222">: </span></span></span><span style="font-size:11.0pt">In our population, dapagliflozin resulted in favorable remodeling of the LV and LA, with improved longitudinal strain and reduced diastolic dysfunction, along with decreased estimated filling pressures and atrial volume. This suggests a potential for dapagliflozin to reverse cardiac remodeling, offering benefits to HF pts.</span></span></span></p>
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