SPC365

SGLT2i on transthyretin amyloid cardiomyopathy: a new drug for an under-recognized cardiomyopathy

Session: Sessão de Posters 14 - Amiloidose Cardíaca
Speaker: Catarina Gregório

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.4 Myocardial Disease – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Catarina Gregório; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Miguel Azaredo Raposo; Ana Abrantes; João Santos Fonseca; Daniel Inácio Cazeiro; Marta Vilela; Fausto J. Pinto; Dulce Brito; João R. Agostinho

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Introduction:</strong> Transthyretin (TTR) stabilizing therapy successfully delays disease progression and reduces heart failure (HF) hospitalizations in patients with cardiac amyloidosis (ATTR-CM). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to be beneficial in heart failure (HF) patients independently of ejection fraction. However, patients with ATTR-CM were excluded form SGLT2i trials, some small observation studies have demonstrated that SGLT2i do not negatively affect hemodynamics in ATTR-CM patients and can present a safety profile in this subgroup of patients.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Aim:</strong> To assess SGLT2i tolerability, impact in clinical outcomes and changes in NTproBNP in patients with ATTR-CM.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Methods: </strong>Single-center retrospective study of ATTR-CM patients treated with tafamidis 61 mg followed in a tertiary center. Patients who were treated with SGLT2i were compared to a group of patients that were never treated with SGLT2i &ndash; control group. Clinical, demographic and echocardiographic parameters, as well as HF admissions, were collected and compared between the two groups.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Results:</strong> A total of 65 patients were included, 58 males, median age of 82&plusmn;7 years, 33 had wild type ATTR and 25 had hereditary ATTR. The SGLT2i group included 43 patients and the control group included 22 patients. The median follow-up (FUP) time was 16&plusmn;13 months. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Despite the lack of statistical differences between groups on NYHA class at baseline or at the end of FUP, there is a tendency to a greater improvement in function class in the SGLT2 group where the 8 patients that were on NYHA III before starting SGLT2i improved to NYHA II or I; in the control group, 1 patient was at NYHA III at baseline and 3 patients were in NYHA III and 1 in NYHA IV at FUP &ndash; Table 1.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">At baseline both groups presented a similar NT-proBNP. However, during follow-up, patients treated with SGLT2i presented a higher level of NT-proBNP (SGLT2i: 1548&plusmn;2564 pg/mL vs. control group: 793&plusmn;1375 pg/mL, p=0.031) and needed diuretic uptitration (p=0.09). Despite these data suggesting that patients in the SGLT2i group had more severe disease, that may had led to SGLT2 initiation, in this group, only one patient had an admission for HF and in the control group 3 patients experienced at least one HF event leading to hospitalization.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">All patients were alive at FUP and, in the SGLT2i group only one patient had to stop the drug due to genitourinary recurrent infections. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Conclusion: </strong>Treatment with SGLT2i on top of tafamidis appears to be linked to an improvement in NYHA functional class and may have prognostic benefits in patients with ATTR-CM. Larger, well dimensioned studies are necessary to assess the definite impact on SGLT2i on HF admissions in this population.</span></span></span></span></p>